Provider Demographics
NPI:1497936991
Name:HANNIBAL HEALTH & REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:HANNIBAL HEALTH & REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-248-1393
Mailing Address - Street 1:7 MELGROVE LN
Mailing Address - Street 2:STE 101
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2275
Mailing Address - Country:US
Mailing Address - Phone:573-248-1393
Mailing Address - Fax:573-248-2189
Practice Address - Street 1:7 MELGROVE LN
Practice Address - Street 2:STE 101
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2275
Practice Address - Country:US
Practice Address - Phone:573-248-1393
Practice Address - Fax:573-248-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003943111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015678Medicare PIN