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General NPI Number Information
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NPI Number | 1316433329
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Entity Type | Organization
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Legal Business Name | 4 UR RECOVERY THERAPY, LLC
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 19201 WARREN ST
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City | DETROIT
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State | MI
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Zip | 48228
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Country | US
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Telephone | 248-327-6766
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Fax | 248-996-8457
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Provider Business Mailing Address
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Address Line | P.O. BOX 7459
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City | DEARBORN
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State | MI
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Zip | 48121
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Country | US
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Telephone | 313-899-0498
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Fax | 248-996-8457
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Authorized Official
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Title or Position | OWNER
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Name | MYRNA FAYAD
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Credential |
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Telephone | 313-551-3316
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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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