Provider Demographics
NPI:1699317669
Name:MEADOW LANE REHABILITATIVE THERAPIES LLC
Entity type:Organization
Organization Name:MEADOW LANE REHABILITATIVE THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUKOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:323-350-2556
Mailing Address - Street 1:1101 S MAIN ST UNIT 602
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-7031
Mailing Address - Country:US
Mailing Address - Phone:233-502-5563
Mailing Address - Fax:
Practice Address - Street 1:1219 MEADOW LN
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1313
Practice Address - Country:US
Practice Address - Phone:323-350-2556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty