Provider Demographics
NPI:1275672073
Name:CENTER FOR NEUROREHABILITATION SERVICES
Entity Type:Organization
Organization Name:CENTER FOR NEUROREHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUETHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-272-0114
Mailing Address - Street 1:7401 BEAUFONT SPRINGS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5520
Mailing Address - Country:US
Mailing Address - Phone:804-272-0114
Mailing Address - Fax:804-272-1125
Practice Address - Street 1:7401 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5520
Practice Address - Country:US
Practice Address - Phone:804-272-0114
Practice Address - Fax:804-272-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010369562084P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350504800OtherDOL PROVIDER NUMBER
VAB25301Medicare UPIN