1881645695 NPI number — INDUSTRIAL REHABILITATION CENTER

Table of content: (NPI 1881645695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881645695 NPI number — INDUSTRIAL REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDUSTRIAL REHABILITATION CENTER
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:
HEALTH AND REHABILITATION CENTER
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:
1881645695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 JACKSON PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLIPOLIS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45631-1560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-446-5387
Provider Business Mailing Address Fax Number:
740-446-5982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 MACCORKLE AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25303-1263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-744-2300
Provider Business Practice Location Address Fax Number:
304-744-8195
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL-MASH
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
740-446-5551

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1036280001 . This is a "MEDICARE DMERC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2219576 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com