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General NPI Number Information
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NPI Number | 1932106945
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Entity Type | Organization
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Legal Business Name | PRIME REHAB SERVICES, INC.
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 2590 ELIZABETH LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-3314
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Country | US
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Telephone | 248-681-0854
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Fax |
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Provider Business Mailing Address
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Address Line | 33341 DEQUINDRE SUITE C
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City | TROY
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State | MI
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Zip | 48083-4630
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Country | US
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Telephone | 248-588-1388
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Fax | 248-543-5205
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. QURATULANN MOGHUL-PLEMONS
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Credential | P.T.
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Telephone | 248-681-0854
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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 |
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License Number State |
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