1245351725 NPI number — REDEEMED REHABILITATIVE CARE SERVICES, INCORPORATED

Table of content: (NPI 1245351725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245351725 NPI number — REDEEMED REHABILITATIVE CARE SERVICES, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDEEMED REHABILITATIVE CARE SERVICES, INCORPORATED
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:
REDEEMED REHAB CARE 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:
1245351725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 14322
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46411-4322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-769-1358
Provider Business Mailing Address Fax Number:
219-769-1383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7870 BROADWAY STE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-769-1358
Provider Business Practice Location Address Fax Number:
219-769-1383
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABIOYE
Authorized Official First Name:
OLADOSU
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-769-1358

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  05007247A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200855540A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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