=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003532136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL RECOVERY AND REHABILITATION CONSULTANTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2022
-----------------------------------------------------
Last Update Date | 10/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19345 PATTON ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48219-2530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-773-2658
-----------------------------------------------------
Fax | 248-927-0750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19345 PATTON ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48219-2530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-773-2658
-----------------------------------------------------
Fax | 248-927-0750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEAD CASE MANAGER
-----------------------------------------------------
Name | DEBORAH INEZ MITCHELL
-----------------------------------------------------
Credential | BSW, RSST
-----------------------------------------------------
Telephone | 248-773-2658
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------