Provider Demographics
NPI:1972904209
Name:IRVINE NEURO REHABILITATION
Entity type:Organization
Organization Name:IRVINE NEURO REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARTESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEAL- WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-415-2500
Mailing Address - Street 1:30066 PONDSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25700 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:248-415-2500
Practice Address - Fax:248-415-2510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRVINE HEAD INJURY HOME, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-05
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center