Provider Demographics
NPI:1164475463
Name:THE REHABILITATION CARE ASSOCIATES INC.
Entity Type:Organization
Organization Name:THE REHABILITATION CARE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FATAI
Authorized Official - Middle Name:BOLAJI
Authorized Official - Last Name:ADISA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-313-0763
Mailing Address - Street 1:952 S.STATE RT 2
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6322
Mailing Address - Country:US
Mailing Address - Phone:219-548-0597
Mailing Address - Fax:219-548-0598
Practice Address - Street 1:952 S.STATE RT 2
Practice Address - Street 2:SUITE 1
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6322
Practice Address - Country:US
Practice Address - Phone:219-548-0597
Practice Address - Fax:219-548-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005905A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN218240Medicare ID - Type UnspecifiedPT:ISSUED ON 06/22/2003.