1073651105 NPI number — PULMONARY REHABILITATION PLUS LTD

Table of content: (NPI 1073651105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073651105 NPI number — PULMONARY REHABILITATION PLUS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY REHABILITATION PLUS LTD
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:
ADVANCED REHABILITATION SERVICES
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:
1073651105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9003 INDIANAPOLIS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-838-5305
Provider Business Mailing Address Fax Number:
219-838-5418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9003 INDIANAPOLIS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-838-5305
Provider Business Practice Location Address Fax Number:
219-838-5418
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TOGLIATTI
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
414-762-1300

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  05009079A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 05007981A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 227800000X , with the licence number: 30004508A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X , with the licence number: 154513 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200178200A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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