Healthcare Provider Details

I. General information

NPI: 1255071676
Provider Name (Legal Business Name): SIDNEY REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUCKEYE AVE
SIDNEY OH
45365-1214
US

IV. Provider business mailing address

1837 E 33RD ST
BROOKLYN NY
11234-4425
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-3171
  • Fax:
Mailing address:
  • Phone: 917-613-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TENENBAUM
Title or Position: CEO
Credential:
Phone: 817-613-5764