Provider Demographics
NPI:1114965670
Name:MEDICAL REHABILITATION ASSOCIATES
Entity Type:Organization
Organization Name:MEDICAL REHABILITATION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-783-6108
Mailing Address - Street 1:77 BATES ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7637
Mailing Address - Country:US
Mailing Address - Phone:207-783-6108
Mailing Address - Fax:207-783-2439
Practice Address - Street 1:77 BATES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7637
Practice Address - Country:US
Practice Address - Phone:207-783-6108
Practice Address - Fax:207-514-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117810100Medicaid
ME=========OtherTAX ID ###
ME=========OtherTAX ID ###