Provider Demographics
NPI:1821784083
Name:REBYLDLLC
Entity Type:Organization
Organization Name:REBYLDLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-688-4752
Mailing Address - Street 1:316 HICKORY KNL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3255
Mailing Address - Country:US
Mailing Address - Phone:770-688-4752
Mailing Address - Fax:
Practice Address - Street 1:316 HICKORY KNL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3255
Practice Address - Country:US
Practice Address - Phone:770-688-4752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBYLDLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care