Provider Demographics
NPI:1528310604
Name:MILESTONE REHABILITATION, LLC
Entity type:Organization
Organization Name:MILESTONE REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-3838
Mailing Address - Street 1:1701 GRANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3160
Mailing Address - Country:US
Mailing Address - Phone:215-856-7623
Mailing Address - Fax:215-969-2736
Practice Address - Street 1:1701 GRANT AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3160
Practice Address - Country:US
Practice Address - Phone:215-856-7623
Practice Address - Fax:215-969-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807427261Q00000X, 261QM2800X
261QM2800X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone