Provider Demographics
NPI:1417370313
Name:URBAN REHAB, INC
Entity Type:Organization
Organization Name:URBAN REHAB, INC
Other - Org Name:UR, INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC II
Authorized Official - Phone:601-927-0188
Mailing Address - Street 1:PO BOX 2305
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-2305
Mailing Address - Country:US
Mailing Address - Phone:601-272-2202
Mailing Address - Fax:866-925-4488
Practice Address - Street 1:901 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5244
Practice Address - Country:US
Practice Address - Phone:601-927-0188
Practice Address - Fax:601-292-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAD09-046M101YA0400X
MSM72171041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06472833Medicaid