Provider Demographics
NPI:1104214055
Name:REHAB DIRECTIVES LLC
Entity Type:Organization
Organization Name:REHAB DIRECTIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONATO
Authorized Official - Middle Name:BALTAZAR
Authorized Official - Last Name:LAZA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:702-499-3764
Mailing Address - Street 1:3213 W CHARLESTON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1991
Mailing Address - Country:US
Mailing Address - Phone:702-570-6222
Mailing Address - Fax:
Practice Address - Street 1:3213 W CHARLESTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1991
Practice Address - Country:US
Practice Address - Phone:702-570-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation