Provider Demographics
NPI:1407376452
Name:MOBILITY REHAB LLC
Entity Type:Organization
Organization Name:MOBILITY REHAB LLC
Other - Org Name:MOBILITY REHAB LLC - EASTDALE ESTATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKSTEAD
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:601-209-7697
Mailing Address - Fax:601-487-6169
Practice Address - Street 1:745 S PEAR ORCHARD ROAD
Practice Address - Street 2:APT 335
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-573-9974
Practice Address - Fax:601-487-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation