Provider Demographics
NPI:1366473282
Name:FAITH REHAB HEALTHCARE, INC.
Entity Type:Organization
Organization Name:FAITH REHAB HEALTHCARE, INC.
Other - Org Name:NA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAQUINDANUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-725-2000
Mailing Address - Street 1:1750 MADISON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6492
Mailing Address - Country:US
Mailing Address - Phone:901-725-2000
Mailing Address - Fax:901-725-2002
Practice Address - Street 1:1750 MADISON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6492
Practice Address - Country:US
Practice Address - Phone:901-725-2000
Practice Address - Fax:901-725-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT 5144225100000X
MOPT 103140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731466Medicaid
TN4115744OtherBCBS GROUP NUMBER
TNDE5742OtherMEDICARE RAILROAD NUMBER
TN3731466Medicaid