Provider Demographics
NPI:1801018106
Name:PREFERRED CARE REHAB
Entity Type:Organization
Organization Name:PREFERRED CARE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYCE-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-279-9949
Mailing Address - Street 1:502 BATTLEGROUND DRIVE
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852
Mailing Address - Country:US
Mailing Address - Phone:662-423-2103
Mailing Address - Fax:662-423-2988
Practice Address - Street 1:502 BATTLEGROUND DRIVE
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852
Practice Address - Country:US
Practice Address - Phone:662-423-2103
Practice Address - Fax:662-423-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01880560Medicaid