Provider Demographics
NPI:1477250702
Name:REBAS FAMILY CARE LLC
Entity Type:Organization
Organization Name:REBAS FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-664-0760
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MO
Mailing Address - Zip Code:65632-0091
Mailing Address - Country:US
Mailing Address - Phone:417-664-0760
Mailing Address - Fax:
Practice Address - Street 1:101 S MYRTLE ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MO
Practice Address - Zip Code:65632-8301
Practice Address - Country:US
Practice Address - Phone:417-664-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health