Provider Demographics
NPI:1417407560
Name:NEUROREHAB ASSOCIATES OF OHIO, LLC
Entity type:Organization
Organization Name:NEUROREHAB ASSOCIATES OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:DE CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-298-3710
Mailing Address - Street 1:20 S 3RD ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4206
Mailing Address - Country:US
Mailing Address - Phone:305-298-3710
Mailing Address - Fax:
Practice Address - Street 1:20 S 3RD ST
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4206
Practice Address - Country:US
Practice Address - Phone:305-298-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty