Provider Demographics
NPI:1780614909
Name:WEST MICHIGAN REHABILITATION PC
Entity type:Organization
Organization Name:WEST MICHIGAN REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-751-2150
Mailing Address - Street 1:3491 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9533
Mailing Address - Country:US
Mailing Address - Phone:269-751-2150
Mailing Address - Fax:616-392-7959
Practice Address - Street 1:3491 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-9533
Practice Address - Country:US
Practice Address - Phone:269-751-2150
Practice Address - Fax:616-392-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation