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General NPI Number Information
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NPI Number | 1326150665
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Entity Type | Organization
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Legal Business Name | OCTAGON REHAB SERVICES, INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 42803 SCHOOLCRAFT RD
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City | PLYMOUTH
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State | MI
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Zip | 48170-2697
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Country | US
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Telephone | 734-542-3150
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Fax | 734-542-3661
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Provider Business Mailing Address
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Address Line | 42803 SCHOOLCRAFT RD
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City | PLYMOUTH
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State | MI
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Zip | 48170-2697
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Country | US
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Telephone | 734-542-3150
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Fax | 734-542-3661
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BABLOO CHACKO
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Credential |
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Telephone | 734-542-3150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 23-6822
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License Number State | MI
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