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General NPI Number Information
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NPI Number | 1093021784
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Entity Type | Organization
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Legal Business Name | MAPLE REHAB LLC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 100 W KIRBY ST SUITE 302
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City | DETROIT
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State | MI
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Zip | 48202-4044
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Country | US
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Telephone | 248-228-4115
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W KIRBY ST SUITE 302
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City | DETROIT
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State | MI
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Zip | 48202-4044
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Country | US
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Telephone | 248-228-4115
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | RAM KANCHARLA
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Credential |
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Telephone | 248-228-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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