1700072279 NPI number — REHAB PROFESSIONALS OF CLEVELAND, INC.

Table of content: (NPI 1700072279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700072279 NPI number — REHAB PROFESSIONALS OF CLEVELAND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB PROFESSIONALS OF CLEVELAND, 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:
1700072279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 TOWN CENTRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROADVIEW HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44147-4008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-526-8566
Provider Business Mailing Address Fax Number:
440-546-8280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 E 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44114-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-566-8566
Provider Business Practice Location Address Fax Number:
440-546-8280
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AUBE'
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-526-8566

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2171000 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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