Provider Demographics
NPI:1710542980
Name:SOUTHEAST OHIO REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHEAST OHIO REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:740-525-5611
Mailing Address - Street 1:145 N 7TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2320
Mailing Address - Country:US
Mailing Address - Phone:740-995-8200
Mailing Address - Fax:
Practice Address - Street 1:145 N 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2320
Practice Address - Country:US
Practice Address - Phone:740-995-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health