1235197302 NPI number — UNIVERSITY REHABILITATION, INC.

Table of content: (NPI 1235197302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235197302 NPI number — UNIVERSITY REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY REHABILITATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235197302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2830 VICTORY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45206-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-245-3617
Provider Business Mailing Address Fax Number:
513-475-7259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 W GALBRAITH RD
Provider Second Line Business Practice Location Address:
DRAKE CENTER
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45216-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-418-2707
Provider Business Practice Location Address Fax Number:
513-418-5838
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GODDARD
Authorized Official First Name:
MARK
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-558-2919

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 50.000932 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2529580 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2331015 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2529393 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2548121 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2609672 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65912933 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0626175 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100011480 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2529437 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50005942 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2330972 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2330981 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2330990 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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