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General NPI Number Information
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NPI Number | 1407361835
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Entity Type | Organization
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Legal Business Name | VENTURE REHAB, LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 5 HAWTHORNE AVE
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City | PIKESVILLE
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State | MD
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Zip | 21208-4815
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Country | US
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Telephone | 540-327-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HAWTHORNE AVE
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City | PIKESVILLE
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State | MD
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Zip | 21208-4815
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Country | US
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Telephone | 540-327-3368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANELL WILSON
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Credential | OTR/L
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Telephone | 540-327-3368
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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 | 07244
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License Number State | MD
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