Healthcare Provider Details

I. General information

NPI: 1659480457
Provider Name (Legal Business Name): STANDISH REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S MAIN ST SUITE G
STANDISH MI
48658
US

IV. Provider business mailing address

P O BOX 1158 529 S MAIN SUITE G
STANDISH MI
48658
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-0937
  • Fax: 989-846-0936
Mailing address:
  • Phone: 989-846-0937
  • Fax: 989-846-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberH
License Number StateMI

VIII. Authorized Official

Name: MR. KRISHNA CHALASANI
Title or Position: ALT ADMINISTRATOR
Credential:
Phone: 989-245-2024