Provider Demographics
NPI:1386062586
Name:KINGDOM REHABILATATION GROUP
Entity type:Organization
Organization Name:KINGDOM REHABILATATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DORENEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-633-8511
Mailing Address - Street 1:2000 TOWN CTR
Mailing Address - Street 2:1900
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1135
Mailing Address - Country:US
Mailing Address - Phone:248-633-8511
Mailing Address - Fax:313-864-7701
Practice Address - Street 1:2000 TOWN CTR
Practice Address - Street 2:1900
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1135
Practice Address - Country:US
Practice Address - Phone:248-633-8511
Practice Address - Fax:313-864-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health