Provider Demographics
NPI:1316136088
Name:SALEM REHABILITATION ASSOCIATES, INC.
Entity type:Organization
Organization Name:SALEM REHABILITATION ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLAKE, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-561-5976
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0845
Mailing Address - Country:US
Mailing Address - Phone:503-561-5902
Mailing Address - Fax:503-561-4912
Practice Address - Street 1:2561 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4600
Practice Address - Country:US
Practice Address - Phone:503-561-5902
Practice Address - Fax:503-561-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213090Medicaid
ORR0000WCJKVMedicare PIN