1881641264 NPI number — PEAK REHABILITATION, INC

Table of content: (NPI 1881641264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881641264 NPI number — PEAK REHABILITATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK 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:
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:
1881641264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30549-2666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-367-1898
Provider Business Mailing Address Fax Number:
706-367-1899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-367-1898
Provider Business Practice Location Address Fax Number:
706-367-1899
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHEEL
Authorized Official First Name:
TIFFANI
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
706-367-1898

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: 344757 . This is a "WELLCARE OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000548941H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRP6725 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 65BBCQX . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1006337 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3951793 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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