Provider Demographics
NPI:1780115527
Name:ADVANCED REHABILITATION CENTER
Entity type:Organization
Organization Name:ADVANCED REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEIMERL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-652-0116
Mailing Address - Street 1:1632 N 18TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-1858
Mailing Address - Country:US
Mailing Address - Phone:920-652-0116
Mailing Address - Fax:920-652-0117
Practice Address - Street 1:1632 N 18TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-1858
Practice Address - Country:US
Practice Address - Phone:920-652-0116
Practice Address - Fax:920-652-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation