Provider Demographics
NPI:1609576875
Name:ALIVE REHAB INC
Entity Type:Organization
Organization Name:ALIVE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI-ANN
Authorized Official - Middle Name:ENGALA
Authorized Official - Last Name:AUSTIN DE CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:516-312-3513
Mailing Address - Street 1:122-48 MILBURN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1033
Mailing Address - Country:US
Mailing Address - Phone:516-312-3513
Mailing Address - Fax:
Practice Address - Street 1:122-48 MILBURN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1033
Practice Address - Country:US
Practice Address - Phone:516-312-3513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALIVE REHAB INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty