Provider Demographics
NPI:1316433329
Name:4 UR RECOVERY THERAPY, LLC
Entity type:Organization
Organization Name:4 UR RECOVERY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-551-3316
Mailing Address - Street 1:P.O. BOX 7459
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121
Mailing Address - Country:US
Mailing Address - Phone:313-899-0498
Mailing Address - Fax:248-996-8457
Practice Address - Street 1:19201 WARREN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228
Practice Address - Country:US
Practice Address - Phone:248-327-6766
Practice Address - Fax:248-996-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)