Provider Demographics
NPI:1811039159
Name:CENTER FOR REHABILITATION & DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:CENTER FOR REHABILITATION & DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-961-1230
Mailing Address - Street 1:4515 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3436
Mailing Address - Country:US
Mailing Address - Phone:540-961-1230
Mailing Address - Fax:540-951-0613
Practice Address - Street 1:4515 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3436
Practice Address - Country:US
Practice Address - Phone:540-961-1230
Practice Address - Fax:540-951-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA191998OtherANTHEM