Provider Demographics
NPI:1033225842
Name:YOUNG REHAB COMPANY PC
Entity type:Organization
Organization Name:YOUNG REHAB COMPANY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:517-349-4268
Mailing Address - Street 1:3530 E HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4041
Mailing Address - Country:US
Mailing Address - Phone:517-349-4268
Mailing Address - Fax:517-349-4298
Practice Address - Street 1:3945 OKEMOS RD STE B2
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4210
Practice Address - Country:US
Practice Address - Phone:517-349-4268
Practice Address - Fax:517-349-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225X00000X, 231H00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N77770Medicare PIN
MI0N77760Medicare PIN
MI0N78410Medicare PIN