Provider Demographics
NPI:1235510546
Name:TOTAL RESPIRATORY AND REHAB, INC
Entity Type:Organization
Organization Name:TOTAL RESPIRATORY AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER, AO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-281-4443
Mailing Address - Street 1:5950 S 118TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4426
Mailing Address - Country:US
Mailing Address - Phone:402-933-0400
Mailing Address - Fax:402-933-8400
Practice Address - Street 1:166 JACKSON ST
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-8906
Practice Address - Country:US
Practice Address - Phone:402-933-0400
Practice Address - Fax:402-933-8400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL RESPIRATORY AND REHAB, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-11
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5763000005Medicare NSC