Provider Demographics
NPI:1144212564
Name:ROME REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:ROME REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT CHT
Authorized Official - Phone:706-802-0780
Mailing Address - Street 1:1801 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-802-0780
Mailing Address - Fax:706-802-0786
Practice Address - Street 1:1801 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:706-802-0780
Practice Address - Fax:706-802-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21168648367OtherBEECHSTREET
=========OtherACORDIA
5142439=========OtherAETNA
=========OtherSTATE HEALTH
21168648367OtherBEECHSTREET
=========OtherPHCS
=========OtherPHCS