Provider Demographics
NPI:1598766396
Name:REHAB SPECIALTIES BY BLACKBURNS, INC.
Entity Type:Organization
Organization Name:REHAB SPECIALTIES BY BLACKBURNS, INC.
Other - Org Name:BLACKBURNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-224-9100
Mailing Address - Street 1:301 CORBET ST
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1877
Mailing Address - Country:US
Mailing Address - Phone:724-224-9100
Mailing Address - Fax:724-224-6108
Practice Address - Street 1:308 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1610
Practice Address - Country:US
Practice Address - Phone:814-454-2863
Practice Address - Fax:814-454-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011925680001Medicaid
0264000001Medicare ID - Type Unspecified