Provider Demographics
NPI:1083611313
Name:COMPREHENSIVE REHABILITATION OF LAFAYETTE INC
Entity Type:Organization
Organization Name:COMPREHENSIVE REHABILITATION OF LAFAYETTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BUFFY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:615-666-5095
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-0629
Mailing Address - Country:US
Mailing Address - Phone:615-666-5095
Mailing Address - Fax:615-666-2254
Practice Address - Street 1:505 ELLINGTON DR STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1074
Practice Address - Country:US
Practice Address - Phone:615-666-5095
Practice Address - Fax:615-802-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37567OtherBCBS OF TN
TN0446520Medicaid
TN37567OtherBCBS OF TN