=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386995421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE CARE REHAB SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2012
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 MAYER RD
-----------------------------------------------------
City | FRANKENMUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48734-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-652-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 CORPORATE OFFICE DR SUITE 150
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48381-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DANIEL WIELECHOWSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-438-2204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------