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General NPI Number Information
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NPI Number | 1548452659
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Entity Type | Organization
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Legal Business Name | SHORELINE REHAB PLC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 9219 WATER ST
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City | MONTAGUE
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State | MI
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Zip | 49437-9206
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Country | US
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Telephone | 231-893-6655
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Fax | 231-893-4902
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Provider Business Mailing Address
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Address Line | 9219 WATER ST
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City | MONTAGUE
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State | MI
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Zip | 49437-9206
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Country | US
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Telephone | 231-893-6655
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Fax | 231-893-4902
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | MRS. BARBARA JEAN BROWN
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Credential | ILPT
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Telephone | 231-893-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5501008363
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License Number State | MI
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