Provider Demographics
NPI:1447553243
Name:PARAMOUNT REHABILITATION SERVICES, PC
Entity type:Organization
Organization Name:PARAMOUNT REHABILITATION SERVICES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANJUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEWAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:989-891-9800
Mailing Address - Street 1:4489 M 61 STE 6
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9272
Mailing Address - Country:US
Mailing Address - Phone:989-718-3171
Mailing Address - Fax:989-718-3181
Practice Address - Street 1:4489 M 61 STE 6
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9104
Practice Address - Country:US
Practice Address - Phone:989-718-3171
Practice Address - Fax:989-718-3172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAMOUNT REHABILITATION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-16
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005570225100000X
MI5501006073225100000X
MI5501013753225100000X
225100000X
MI1022345225X00000X
MI1051100450225XH1200X
MI5201007687225XP0200X
MI01092746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0987906OtherHEALTH PLUS
MI30738OtherBLUE CARE NETWORK
MI30738OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI404679870Medicaid
MI236819Medicare PIN