Provider Demographics
NPI:1649407123
Name:EXOUSIA REHABILITATIVE SERVICES INC.
Entity Type:Organization
Organization Name:EXOUSIA REHABILITATIVE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TARONE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MA/OT
Authorized Official - Phone:330-788-2115
Mailing Address - Street 1:3940 LOCKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3522
Mailing Address - Country:US
Mailing Address - Phone:330-788-2115
Mailing Address - Fax:234-252-7650
Practice Address - Street 1:211 REDONDO RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1805
Practice Address - Country:US
Practice Address - Phone:330-788-2115
Practice Address - Fax:234-232-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT05585252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5003276OtherOHIO DODD
OH3097536Medicaid