Provider Demographics
NPI:1134124647
Name:EASTER SEAL REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:EASTER SEAL REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-242-1390
Mailing Address - Street 1:1305 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5705
Mailing Address - Country:US
Mailing Address - Phone:304-242-1390
Mailing Address - Fax:304-243-5880
Practice Address - Street 1:1305 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5705
Practice Address - Country:US
Practice Address - Phone:304-242-1390
Practice Address - Fax:304-243-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV138712081P0010X
225100000X, 225X00000X, 231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0641961Medicaid
WV0008998000Medicaid
OH0641961Medicaid
WV516516Medicare Oscar/Certification
WV9315641Medicare PIN