Provider Demographics
NPI:1265025522
Name:TRI-VISTA REHAB, INC
Entity Type:Organization
Organization Name:TRI-VISTA REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:662-840-0535
Mailing Address - Street 1:PO BOX 3592
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3592
Mailing Address - Country:US
Mailing Address - Phone:662-840-0535
Mailing Address - Fax:662-842-7915
Practice Address - Street 1:411 OAK ST.
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476
Practice Address - Country:US
Practice Address - Phone:662-270-6486
Practice Address - Fax:662-842-7915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-VISTA REHAB, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation