Provider Demographics
NPI:1003375411
Name:NEURO REHABCARE-TASS
Entity Type:Organization
Organization Name:NEURO REHABCARE-TASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:601-892-4384
Mailing Address - Street 1:512 HARMONY ROAD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059
Mailing Address - Country:US
Mailing Address - Phone:601-892-4384
Mailing Address - Fax:601-892-4386
Practice Address - Street 1:512 HARMONY ROAD
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059
Practice Address - Country:US
Practice Address - Phone:601-892-4384
Practice Address - Fax:601-892-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01OtherSTATE LICENSE