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General NPI Number Information
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NPI Number | 1972904209
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Entity Type | Organization
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Legal Business Name | IRVINE NEURO REHABILITATION
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 25700 LAHSER RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033
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Country | US
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Telephone | 248-415-2500
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Fax | 248-415-2510
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Provider Business Mailing Address
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Address Line | 30066 PONDSVIEW DR
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City | FRANKLIN
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State | MI
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Zip | 48025-1524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIOR
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Name | MRS. ARTESIA MCNEAL- WASHINGTON
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Credential |
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Telephone | 248-415-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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