Provider Demographics
NPI:1306957188
Name:WESTERN RESERVE REHAB GROUP, LLC
Entity type:Organization
Organization Name:WESTERN RESERVE REHAB GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-702-6944
Mailing Address - Street 1:4628 SW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3019
Mailing Address - Country:US
Mailing Address - Phone:216-702-6944
Mailing Address - Fax:503-477-7338
Practice Address - Street 1:155 5TH ST NE
Practice Address - Street 2:6TH FLOOR REHAB
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3332
Practice Address - Country:US
Practice Address - Phone:216-702-6944
Practice Address - Fax:503-477-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2344538Medicaid
OH9326661Medicare PIN
DA3487Medicare PIN