1700195286 NPI number — ENCORE REHABILITATION, INC.

Table of content: (NPI 1700195286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700195286 NPI number — ENCORE REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENCORE REHABILITATION, 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:
1700195286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILOXI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39535-8087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-388-5714
Provider Business Mailing Address Fax Number:
228-388-0017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5132 BEATLINE RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39560-3869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-575-8429
Provider Business Practice Location Address Fax Number:
228-575-8891
Provider Enumeration Date:
09/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-350-1764

Provider Taxonomy Codes

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

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

  • Identifier: 1033218524 . This is a "GROUP NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 09015077 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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