Provider Demographics
NPI:1689054645
Name:REHAB AND WELLNESS LLC
Entity Type:Organization
Organization Name:REHAB AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-387-9787
Mailing Address - Street 1:1090 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3959
Mailing Address - Country:US
Mailing Address - Phone:205-387-1189
Mailing Address - Fax:855-518-2419
Practice Address - Street 1:1090 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3959
Practice Address - Country:US
Practice Address - Phone:205-387-1189
Practice Address - Fax:855-518-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD24363261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G703517OtherMEDICARE PTAN GROUP
AL187219Medicaid
AL176731Medicaid
AL51171825OtherBCBS OF ALABAMA