1609813989 NPI number — HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.

Table of content: (NPI 1609813989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609813989 NPI number — HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMAN PERFORMANCE AND REHABILITATION CENTERS, 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:
HPRC, INC.
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:
1609813989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31908-8068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-320-5461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6298 VETERANS PKWY
Provider Second Line Business Practice Location Address:
SUITE 5A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31909-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-324-3558
Provider Business Practice Location Address Fax Number:
706-320-5484
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MC CLUSKEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
706-322-7762

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251E1300X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 300023633B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529602320 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP1100 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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