Provider Demographics
NPI:1760420327
Name:DIVERSIFIED REHAB SERVICES, LLC
Entity Type:Organization
Organization Name:DIVERSIFIED REHAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-534-9678
Mailing Address - Street 1:101 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-3464
Mailing Address - Country:US
Mailing Address - Phone:618-534-9678
Mailing Address - Fax:618-435-2346
Practice Address - Street 1:429 S BLANCHE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MOUNDS
Practice Address - State:IL
Practice Address - Zip Code:62964-1107
Practice Address - Country:US
Practice Address - Phone:618-745-9419
Practice Address - Fax:618-745-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy