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General NPI Number Information
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NPI Number | 1386062586
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Entity Type | Organization
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Legal Business Name | KINGDOM REHABILATATION GROUP
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 2000 TOWN CTR 1900
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1135
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Country | US
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Telephone | 248-633-8511
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Fax | 313-864-7701
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Provider Business Mailing Address
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Address Line | 2000 TOWN CTR 1900
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1135
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Country | US
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Telephone | 248-633-8511
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Fax | 313-864-7701
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | DORENEA BYRD
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Credential |
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Telephone | 248-633-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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