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General NPI Number Information
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NPI Number | 1114348687
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Entity Type | Organization
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Legal Business Name | SUPERIOR REHABILITATION & PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 12/30/2013
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 1310 S FRONT ST SUITE C
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City | MARQUETTE
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State | MI
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Zip | 49855-5185
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Country | US
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Telephone | 906-273-1517
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Fax | 906-273-1519
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Provider Business Mailing Address
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Address Line | 1310 S FRONT ST SUITE C
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City | MARQUETTE
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State | MI
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Zip | 49855-5185
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Country | US
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Telephone | 906-273-1517
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Fax | 906-273-1519
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | WENDI THOMAS
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Credential |
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Telephone | 906-273-1517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | MI
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