Provider Demographics
NPI:1043655665
Name:LANCASTER REHAB & DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:LANCASTER REHAB & DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KORDACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-5025
Mailing Address - Street 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 140, ROOM D
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-687-5025
Mailing Address - Fax:740-687-4570
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 140, ROOM D
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-687-5025
Practice Address - Fax:740-687-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy