Basic Information
| Provider Information | |||||||||
| NPI: | 1124300199 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRIA HOME REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41521 W 11 MILE RD | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482990030 | ||||||||
| FaxNumber: | 2489121566 | ||||||||
| Practice Location | |||||||||
| Address1: | 41521 W 11 MILE RD | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482990030 | ||||||||
| FaxNumber: | 2489121566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2011 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | WILCOX | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2482990030 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | N | Agencies | Nursing Care | 253Z00000X | N | Agencies | In Home Supportive Care | 251E00000X | Y | Agencies | Home Health |
No ID Information.