Provider Demographics
NPI:1003942194
Name:SOCIETY FOR REHABITITATION
Entity Type:Organization
Organization Name:SOCIETY FOR REHABITITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-352-8993
Mailing Address - Street 1:9521 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1613
Mailing Address - Country:US
Mailing Address - Phone:440-352-8993
Mailing Address - Fax:440-352-6632
Practice Address - Street 1:9521 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1613
Practice Address - Country:US
Practice Address - Phone:440-352-8993
Practice Address - Fax:440-352-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364501Medicare ID - Type Unspecified
OH1408560Medicare ID - Type Unspecified