Provider Demographics
NPI:1225113269
Name:COMMUNITY CARE REHABILITATION, LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-327-1402
Mailing Address - Street 1:23835 HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:MO
Mailing Address - Zip Code:65275-2276
Mailing Address - Country:US
Mailing Address - Phone:660-327-1402
Mailing Address - Fax:660-327-1403
Practice Address - Street 1:23835 HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:MO
Practice Address - Zip Code:65275-2276
Practice Address - Country:US
Practice Address - Phone:660-327-1402
Practice Address - Fax:660-327-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty