Organization
SHORELINE REHAB PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA JEAN BROWN ILPT (MEMBER/OWNER)
(231) 893-6655
Entity
Organization
Contact information
Practice address
9219 WATER ST, MONTAGUE, MI 49437-9206
(231) 893-6655
(231) 893-4902
Mailing address
9219 WATER ST, MONTAGUE, MI 49437-9206
(231) 893-6655
(231) 893-4902
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5501008363
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1908559
—
MI
01
—
650F157050
BLUE CROSS BLUE SHIELD
MI
01
—
650F157060M
BLUE CROSS BLUE SHIELD
MI
01
—
DE3646
RAILROAD MEDICARE GROUP
MI
Enumeration date
08/13/2007
Last updated
05/21/2013
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