Provider Demographics
NPI:1295466670
Name:MOBILITY REHAB LLC
Entity Type:Organization
Organization Name:MOBILITY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RICHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-209-7697
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-1227
Mailing Address - Country:US
Mailing Address - Phone:601-573-9974
Mailing Address - Fax:601-487-8546
Practice Address - Street 1:650 S UNIVERSITY BLVD APT 340
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7869
Practice Address - Country:US
Practice Address - Phone:601-573-9974
Practice Address - Fax:601-487-8546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBILITY REHAB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation