Provider Demographics
NPI:1780850529
Name:MAGNUM REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:MAGNUM REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-730-7579
Mailing Address - Street 1:20526 PLYMOUTH RD STE B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1273
Mailing Address - Country:US
Mailing Address - Phone:734-730-7579
Mailing Address - Fax:
Practice Address - Street 1:20526 PLYMOUTH RD STE B
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1273
Practice Address - Country:US
Practice Address - Phone:734-730-7579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty