Provider Demographics
NPI:1487604203
Name:IN HOME REHAB OF DICKINSON COUNTY
Entity type:Organization
Organization Name:IN HOME REHAB OF DICKINSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:906-563-8920
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:MI
Mailing Address - Zip Code:49852-0163
Mailing Address - Country:US
Mailing Address - Phone:906-563-8920
Mailing Address - Fax:906-563-8942
Practice Address - Street 1:W3101 RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:VULCAN
Practice Address - State:MI
Practice Address - Zip Code:49892-8290
Practice Address - Country:US
Practice Address - Phone:906-563-8920
Practice Address - Fax:906-563-8942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650B210460OtherBCBS
MIDE7826OtherRAILROAD
MI0P33510Medicare PIN
MI650B210460OtherBCBS
MI0P33380Medicare PIN