1609952159 NPI number — REHAB RESOURCES UNLIMITED, INC

Table of content: (NPI 1609952159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609952159 NPI number — REHAB RESOURCES UNLIMITED, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB RESOURCES UNLIMITED, 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:
1609952159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 822394
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICKSBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39182-2394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-638-4076
Provider Business Mailing Address Fax Number:
601-638-4979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 JOHNSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLULAH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71282-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-574-5273
Provider Business Practice Location Address Fax Number:
318-574-2218
Provider Enumeration Date:
10/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
FERMIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
601-638-4076

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1476749 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G9304 . This is a "BLUE CROSS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".