Provider Demographics
NPI:1871546739
Name:PORT HURON THERAPY CENTER LLC
Entity type:Organization
Organization Name:PORT HURON THERAPY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-385-9808
Mailing Address - Street 1:34051 GRATIOT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3592
Mailing Address - Country:US
Mailing Address - Phone:810-385-9808
Mailing Address - Fax:586-415-7800
Practice Address - Street 1:34051 GRATIOT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3592
Practice Address - Country:US
Practice Address - Phone:810-385-9808
Practice Address - Fax:586-415-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI137801OtherCARE CHOICES PPO
MI5135045OtherCIGNA PPO
MI142585Medicaid
MI30426OtherBLUE CROSS BLUE SHIELD
MI4704356Medicaid
MI234528OtherHEALTH ALLIANCE PLAN
MI30322Medicaid
MI5135045OtherCIGNA PPO
MI234528Medicare Oscar/Certification