Provider Demographics
NPI:1508917667
Name:ADVANCED REHAB CENTER INC
Entity Type:Organization
Organization Name:ADVANCED REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-446-2333
Mailing Address - Street 1:P.O. BOX 71265
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708
Mailing Address - Country:US
Mailing Address - Phone:229-446-2333
Mailing Address - Fax:229-446-7733
Practice Address - Street 1:709-A NORTH WESTOVER BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-446-2333
Practice Address - Fax:229-446-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4159Medicare UPIN
GAGRP4159Medicare PIN