1144363482 NPI number — REHABILITATION SCVS OF MT STERLING

Table of content: (NPI 1144363482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144363482 NPI number — REHABILITATION SCVS OF MT STERLING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION SCVS OF MT STERLING
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:
1144363482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 STERLING WAY
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MT STERLING
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-497-7061
Provider Business Mailing Address Fax Number:
859-497-7063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 STERLING WAY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-497-7061
Provider Business Practice Location Address Fax Number:
859-497-7063
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
859-497-7061

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  003353 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X , with the licence number: KYR2445 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 000000489979 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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