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General NPI Number Information
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NPI Number | 1912139288
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Entity Type | Organization
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Legal Business Name | AT HOME REHAB, LLC
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 5088 CORPORATE EXCHANGE BLVD SE STE. 350
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-5517
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Country | US
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Telephone | 800-880-9715
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Fax | 800-880-9715
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Provider Business Mailing Address
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Address Line | 5088 CORPORATE EXCHANGE BLVD SE STE. 350
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-5517
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Country | US
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Telephone | 800-880-9715
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Fax | 800-880-9715
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Authorized Official
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Title or Position | CEO
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Name | TARA L ANDERSON
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Credential | MPT
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Telephone | 800-880-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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