1790882926 NPI number — FULLER REHABILITATION AND CONSULTING SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790882926 NPI number — FULLER REHABILITATION AND CONSULTING SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULLER REHABILITATION AND CONSULTING SERVICES 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:
6
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:
1790882926
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:
529 ROLLINS INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
P.O. BOX 615
Provider Business Mailing Address City Name:
RINGGOLD
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30736-2872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-965-6131
Provider Business Mailing Address Fax Number:
706-965-3801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6064 WILMINGTON PIKE
Provider Second Line Business Practice Location Address:
SUGARCREEK PLAZA SHOPPING CENTER
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-848-4300
Provider Business Practice Location Address Fax Number:
937-848-4310
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MULLIS
Authorized Official First Name:
WANDA
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
706-965-0323

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2552910 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com