1174993901 NPI number — RIVER CITY REHAB & VOCATIONAL SERVICES, LLC

Table of content: (NPI 1174993901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174993901 NPI number — RIVER CITY REHAB & VOCATIONAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER CITY REHAB & VOCATIONAL SERVICES, LLC
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:
1174993901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELERSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45694-0251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-935-0685
Provider Business Mailing Address Fax Number:
740-981-3173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 DEWEY ST
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
WHEELERSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45694-1757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-935-0685
Provider Business Practice Location Address Fax Number:
740-981-3173
Provider Enumeration Date:
10/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOM
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER - OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
740-935-0685

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  R0952 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1801807185 . This is a "INDIVIDUAL NPI NUMBER" identifier . This identifiers is of the category "OTHER".




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