Provider Demographics
NPI:1578667754
Name:MED REHAB SERVICES, INC.
Entity type:Organization
Organization Name:MED REHAB SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMS
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-203-6636
Mailing Address - Street 1:32290 W 5 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:248-203-6636
Mailing Address - Fax:248-203-6634
Practice Address - Street 1:32290 W 5 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:248-203-6636
Practice Address - Fax:248-203-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30420OtherBLUE CROSS/BLUE SHIELD
23-6788Medicare ID - Type Unspecified