Provider Demographics
NPI:1467669226
Name:RADICAL REHAB SOLUTIONS, LLC
Entity Type:Organization
Organization Name:RADICAL REHAB SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:PHIFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-781-2510
Mailing Address - Street 1:PO BOX 6456
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25772-6456
Mailing Address - Country:US
Mailing Address - Phone:304-781-2510
Mailing Address - Fax:304-525-3311
Practice Address - Street 1:314 9TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1436
Practice Address - Country:US
Practice Address - Phone:304-781-2510
Practice Address - Fax:304-525-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1700045600Medicaid
WV03810OtherW V WORKER'S COMP