Provider Demographics
NPI:1588179923
Name:INNOVATE REHAB AND WELLNESS LLC
Entity Type:Organization
Organization Name:INNOVATE REHAB AND WELLNESS LLC
Other - Org Name:HILLCREST REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHISON ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-682-4800
Mailing Address - Street 1:1902 HARLAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-6609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1804 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3663
Practice Address - Country:US
Practice Address - Phone:402-682-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy