Provider Demographics
NPI:1639171689
Name:ROMAN REHAB INC.
Entity Type:Organization
Organization Name:ROMAN REHAB INC.
Other - Org Name:ROMAN WHEELCHAIRS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VAN HOORN
Authorized Official - Suffix:
Authorized Official - Credentials:CRTS
Authorized Official - Phone:706-235-8113
Mailing Address - Street 1:432 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4272
Mailing Address - Country:US
Mailing Address - Phone:706-235-8113
Mailing Address - Fax:706-235-9108
Practice Address - Street 1:432 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4272
Practice Address - Country:US
Practice Address - Phone:706-235-8113
Practice Address - Fax:706-235-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001084332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00891987AMedicaid
GA3972890001Medicare ID - Type UnspecifiedPROVIDER NUMBER