| NPI | 1255967808 |
|---|---|
| Doing Business As | POWERBACK REHABILITATION LAKEWOOD |
| Entity Type | Organization |
| Authorized Contact | MICHAEL THEODORE BERG VP Asst Secretary 505-468-4742 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 385H00000X Respite Care |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2020-03-16 |