Organization Name: | NOVACARE OUTPATIENT REHABILIATION EAST INC |
NPI Number: | 1023208881 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL TARVIN (VICE PRESIDENT) |
Mailing Address: | 8290 University Ave Ne Suite 300 Fridley |
State: | MN US |
Postal Code: | 554321847 |
Phone Number: | 7179754503 |
Fax Number: | |
NPI Enumeration Date: | 07/27/2007 |
NPI Last Update Date: | 03/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |