Provider Demographics
NPI:1801419239
Name:REGION HOME THERAPY CORP
Entity Type:Organization
Organization Name:REGION HOME THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-463-3927
Mailing Address - Street 1:854 E BROADWAY APT 3P
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4731
Mailing Address - Country:US
Mailing Address - Phone:646-463-3927
Mailing Address - Fax:
Practice Address - Street 1:854 E BROADWAY APT 3P
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4731
Practice Address - Country:US
Practice Address - Phone:646-463-3927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1275047763OtherNPI