Provider Demographics
NPI:1285907899
Name:PROFESSIONAL ASSOCIATES IN REHABILITATION LLC
Entity type:Organization
Organization Name:PROFESSIONAL ASSOCIATES IN REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FABIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-887-9801
Mailing Address - Street 1:2929 COVINGTON CT
Mailing Address - Street 2:STE. 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4941
Mailing Address - Country:US
Mailing Address - Phone:517-371-4971
Mailing Address - Fax:517-371-4475
Practice Address - Street 1:3960 PATIENT CARE WAY
Practice Address - Street 2:STE. 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4275
Practice Address - Country:US
Practice Address - Phone:517-887-9801
Practice Address - Fax:517-887-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
MI330225103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty