Provider Demographics
NPI:1710039656
Name:REHABILITATION SERVICES OF CLEVELAND, INC.
Entity Type:Organization
Organization Name:REHABILITATION SERVICES OF CLEVELAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-3004
Mailing Address - Street 1:712 N CHRISMAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2107
Mailing Address - Country:US
Mailing Address - Phone:662-843-3004
Mailing Address - Fax:662-843-0820
Practice Address - Street 1:712 N CHRISMAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2107
Practice Address - Country:US
Practice Address - Phone:662-843-3004
Practice Address - Fax:662-843-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1494225100000X
MSOT0355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117948Medicaid
MS00117850Medicaid
MS00117850Medicaid
650000060Medicare ID - Type Unspecified
1033138813Medicare UPIN
670000009Medicare ID - Type Unspecified