Provider Demographics
NPI:1366502031
Name:OHIO REHAB & DIAGNOSTIC CENTER, INC.
Entity Type:Organization
Organization Name:OHIO REHAB & DIAGNOSTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KORDACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-0036
Mailing Address - Street 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-687-5025
Mailing Address - Fax:740-687-4570
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 140
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-687-5025
Practice Address - Fax:740-687-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL11021332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460540Medicaid
OH0460540Medicaid