Provider Demographics
NPI:1659457158
Name:DEREK ENTERPRISES LLC
Entity Type:Organization
Organization Name:DEREK ENTERPRISES LLC
Other - Org Name:PRO REHABILITIATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MGR TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASSETORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-823-7761
Mailing Address - Street 1:1086 ROUTE 315
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-823-7761
Mailing Address - Fax:570-822-8033
Practice Address - Street 1:106 ROTARY DRIVE
Practice Address - Street 2:VALMONT INDUSTRIAL PARK
Practice Address - City:W HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-459-6333
Practice Address - Fax:570-459-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50042164OtherCAPITAL BCBS
PA61915OtherGEISINGER
PA118707500OtherUS DEPT OF LABOR
PA315464OtherHEALTH AMERICA HLTH ASSUR
PA5234560OtherAETNA US HEALTHCARE
PA1507382OtherHIGHMARK BCBS