Provider Demographics
NPI:1467601799
Name:HOME INSTEAD REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:HOME INSTEAD REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-317-9593
Mailing Address - Street 1:106 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4709
Mailing Address - Country:US
Mailing Address - Phone:516-317-9593
Mailing Address - Fax:
Practice Address - Street 1:106 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4709
Practice Address - Country:US
Practice Address - Phone:516-317-9593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014577-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty