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General NPI Number Information
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NPI Number | 1336682772
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Entity Type | Organization
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Legal Business Name | ESPRIT REHAB, LLC
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 8838 HENDRICKS DR
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City | BRIGHTON
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State | MI
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Zip | 48116-9111
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Country | US
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Telephone | 734-320-2513
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Fax | 734-212-2292
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Provider Business Mailing Address
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Address Line | 8838 HENDRICKS DR
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City | BRIGHTON
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State | MI
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Zip | 48116-9111
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Country | US
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Telephone | 734-320-2513
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Fax | 734-212-2292
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Authorized Official
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Title or Position | CEO
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Name | KATHERINE L BRACISZEWSKI
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Credential | RN, BSN
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Telephone | 734-320-2513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | 4704116401
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License Number State | MI
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