Provider Demographics
NPI:1376911065
Name:FALL INJURY PREVENTION AND REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:FALL INJURY PREVENTION AND REHABILITATION SERVICES LLC
Other - Org Name:FALL INJURY PREVENTION AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:FRIESON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP
Authorized Official - Phone:205-518-6421
Mailing Address - Street 1:7001 CRESTWOOD BLVD
Mailing Address - Street 2:SUITE 804
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2332
Mailing Address - Country:US
Mailing Address - Phone:205-518-6421
Mailing Address - Fax:
Practice Address - Street 1:7001 CRESTWOOD BLVD
Practice Address - Street 2:SUITE 804
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2332
Practice Address - Country:US
Practice Address - Phone:205-518-6421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1056275261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000031454Medicaid
ALS21146Medicare UPIN