Provider Demographics
NPI:1467419770
Name:CHILDRENS FIRST REHAB SERVICES, INC.
Entity Type:Organization
Organization Name:CHILDRENS FIRST REHAB SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-428-6915
Mailing Address - Street 1:5129 WARREN DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-4035
Mailing Address - Country:US
Mailing Address - Phone:812-428-6915
Mailing Address - Fax:812-491-9615
Practice Address - Street 1:1610 DIVISION ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-6683
Practice Address - Country:US
Practice Address - Phone:812-428-6915
Practice Address - Fax:812-491-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200367520AMedicaid
IN200367520AMedicaid
KY00049Medicare PIN