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General NPI Number Information
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NPI Number | 1659480457
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Entity Type | Organization
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Legal Business Name | STANDISH REHABILITATION CENTER INC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 529 S MAIN ST SUITE G
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City | STANDISH
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State | MI
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Zip | 48658
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Country | US
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Telephone | 989-846-0937
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Fax | 989-846-0936
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Provider Business Mailing Address
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Address Line | P O BOX 1158 529 S MAIN SUITE G
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City | STANDISH
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State | MI
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Zip | 48658
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Country | US
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Telephone | 989-846-0937
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Fax | 989-846-0936
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Authorized Official
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Title or Position | ALT ADMINISTRATOR
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Name | MR. KRISHNA CHALASANI
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Credential |
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Telephone | 989-245-2024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | H
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License Number State | MI
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