Provider Demographics
NPI:1609829449
Name:MOUNTAINCREST REHAB OF LOWELL
Entity Type:Organization
Organization Name:MOUNTAINCREST REHAB OF LOWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAMARILLO
Authorized Official - Last Name:SEBAG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-743-5573
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-0841
Mailing Address - Country:US
Mailing Address - Phone:870-743-5573
Mailing Address - Fax:870-743-5974
Practice Address - Street 1:212 S LINCOLN ST
Practice Address - Street 2:SUITE D
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:479-770-5655
Practice Address - Fax:479-770-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F334Medicare ID - Type Unspecified