MEDICARE: MID-ATLANTIC REHABILITATION SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		PA

General Provider Information

NPI Number	:	1396912440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC REHABILITATION SERVICES, INC

Provider Business Mailing Address
First Line	:	743 N 24TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2539
Country	:	US
Telephone Number	:	215-763-3992
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 N 24TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2539
Country	:	US
Telephone Number	:	215-763-3992
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL MACDONALD
Credential	:
Telephone Number	:	215-763-3992

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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