1205106457 NPI number — KEY REHABILITATION, INC

Table of content: (NPI 1205106457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205106457 NPI number — KEY REHABILITATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEY 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:
GEROPSYCH, A DIVISION OF KEY REHABILITATION, INC
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:
1205106457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 NW BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129-4428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-896-6400
Provider Business Mailing Address Fax Number:
615-896-5177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 BEDFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66030-1185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-856-6520
Provider Business Practice Location Address Fax Number:
615-896-5177
Provider Enumeration Date:
01/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
JANET
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
615-896-6400

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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