Provider Demographics
NPI:1164545364
Name:HOME REHABILITATION AND CONSULTANT SERVICES, PC
Entity Type:Organization
Organization Name:HOME REHABILITATION AND CONSULTANT SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, PT
Authorized Official - Phone:816-517-6648
Mailing Address - Street 1:902 NW 750TH RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64019-9128
Mailing Address - Country:US
Mailing Address - Phone:816-230-1590
Mailing Address - Fax:
Practice Address - Street 1:902 NW 750TH RD
Practice Address - Street 2:
Practice Address - City:CENTERVIEW
Practice Address - State:MO
Practice Address - Zip Code:64019-9128
Practice Address - Country:US
Practice Address - Phone:816-230-1590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO28243OtherBCBS PROVIDER NUMBER
MO28243OtherBCBS PROVIDER NUMBER