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General NPI Number Information
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NPI Number | 1548417686
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Entity Type | Organization
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Legal Business Name | INTEGRATED REHABILITAION CENTER INC
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 5800 MONROE ST SUITE 8E
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City | SYLVANIA
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State | OH
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Zip | 43560-2263
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Country | US
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Telephone | 419-517-1380
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Fax | 419-517-1381
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Provider Business Mailing Address
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Address Line | 5800 MONROE ST SUITE 8E
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City | SYLVANIA
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State | OH
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Zip | 43560-2263
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Country | US
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Telephone | 419-517-1380
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Fax | 419-517-1381
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PROF. TAMARA E MCMURRAY
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Credential |
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Telephone | 419-517-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | NM05428
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License Number State | OH
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