Provider Demographics
NPI:1346429644
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 MURPHY
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 1:2561 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:503-561-5976
Practice Address - Fax:503-561-4912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN RESERVE REHAB GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27171225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006277Medicaid
ORR138225Medicare PIN
ORR151750Medicare PIN