1285743021 NPI number — COMMUNITY REHAB, INC.

Table of content: (NPI 1285743021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285743021 NPI number — COMMUNITY REHAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY REHAB, 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:
COMMUNITY REHAB
Provider Other Organization Name Type Code:
3
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:
1285743021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14450 EAGLE RUN DR STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68116-1493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-504-1330
Provider Business Mailing Address Fax Number:
402-504-1335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14450 EAGLE RUN DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68116-1493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-504-1330
Provider Business Practice Location Address Fax Number:
402-504-1335
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THEILER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
402-721-3908

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  N/A , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025040000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01805 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0586339 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: S561 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 193153205 . This is a "DOL-OWCP" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 6400610 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83270 . This is a "COVENTRY" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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