Organization Active NPI

Quality Recreation & Rehabilitation

  • Internal Medicine Physician
  • Detroit, MI
National Provider Identifier
1144351404
Registry record updated May 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
AH051664 Issued in MI
Legal business name
QUALITY RECREATION & REHABILITATION
Practice address
2641 W. Grand Blvd.
Detroit, MI 48202
Phone
(313) 874-3129
Fax
(248) 354-3901
NPI assigned
Mar 8, 2007
Last updated
May 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Beth R Jenkins
Title
Program Director
Phone
(313) 874-3129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X AH051664 MI Primary

Addresses

Primary practice location

2641 W. Grand Blvd.
Detroit, MI 48202

Mailing address

2641 W Grand Blvd
Detroit, MI 48208-1234
Phone (313) 874-3129

Other identifiers 2

IdentifierTypeStateIssuer
104662210MedicaidMI
110H222590OtherMIBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

801 Virginia Park St
Detroit, MI 48202
Phone (248) 539-4640

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211760000000",
    "number": "1144351404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2641 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482081234",
            "telephone_number": "313-874-3129",
            "fax_number": "248-354-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2641 W. GRAND BLVD.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "313-874-3129",
            "fax_number": "248-354-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY RECREATION & REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2008-05-26",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "313-874-3129",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "AH051664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104662210",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "110H222590",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.