1609812411 NPI number — PREHAB INC.

Table of content: (NPI 1609812411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609812411 NPI number — PREHAB INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREHAB 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:
1609812411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POST OFFICE BOX 240698
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36124-0698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-270-1630
Provider Business Mailing Address Fax Number:
877-877-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8355 CROSSLAND LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-8483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-270-1630
Provider Business Practice Location Address Fax Number:
877-877-8383
Provider Enumeration Date:
06/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STINSON
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-270-1630

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  502 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051008224 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: IN009927585 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".