Provider Demographics
NPI:1114272374
Name:SELECT REHAB
Entity Type:Organization
Organization Name:SELECT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-840-1588
Mailing Address - Street 1:2180 S FORREST HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2971
Mailing Address - Country:US
Mailing Address - Phone:417-840-1588
Mailing Address - Fax:
Practice Address - Street 1:1707 W ELFINDALE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1246
Practice Address - Country:US
Practice Address - Phone:417-831-2273
Practice Address - Fax:417-831-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116911313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility