Provider Demographics
NPI:1902115769
Name:GREAT EAST REHABILITATION LLC
Entity Type:Organization
Organization Name:GREAT EAST REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MULICHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-652-2287
Mailing Address - Street 1:2103 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3067
Mailing Address - Country:US
Mailing Address - Phone:330-652-2287
Mailing Address - Fax:330-544-3904
Practice Address - Street 1:2103 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3067
Practice Address - Country:US
Practice Address - Phone:330-652-2287
Practice Address - Fax:330-544-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0046362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty