Provider Demographics
NPI:1003881095
Name:ACTS REHABILITATION SERVICES, INC
Entity Type:Organization
Organization Name:ACTS REHABILITATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNTUASE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:856-794-2100
Mailing Address - Street 1:611 E LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8004
Mailing Address - Country:US
Mailing Address - Phone:856-794-2100
Mailing Address - Fax:856-794-2120
Practice Address - Street 1:611 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8004
Practice Address - Country:US
Practice Address - Phone:856-794-2100
Practice Address - Fax:856-794-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00598500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2115735000OtherAMERIHEALTH
NJ092680OtherMEDICARE GROUP #
NJ2065081OtherUS HEALTHCARE
NJ5719663OtherAETNA US HEALTHCARE
NJP00040938OtherRAILROAD MEDICARE
NJ092680OtherMEDICARE GROUP #