Provider Demographics
NPI:1003233271
Name:ENCORE REHABILITATION INC
Entity Type:Organization
Organization Name:ENCORE REHABILITATION INC
Other - Org Name:ENCORE REHAB OF GRENADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:K
Authorized Official - Last Name:USELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-388-5714
Mailing Address - Street 1:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:228-388-0017
Practice Address - Street 1:1322C SUNSET DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4000
Practice Address - Country:US
Practice Address - Phone:228-388-5714
Practice Address - Fax:228-388-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015077Medicaid
MS09015077Medicaid