Provider Demographics
NPI:1902188287
Name:RELIANT CARE REHABILITATIVE SERVICES L L C
Entity Type:Organization
Organization Name:RELIANT CARE REHABILITATIVE SERVICES L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DESTEFANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-3800
Mailing Address - Street 1:2011 CORONA RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2548
Mailing Address - Country:US
Mailing Address - Phone:314-543-3860
Mailing Address - Fax:314-272-0343
Practice Address - Street 1:2011 CORONA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2548
Practice Address - Country:US
Practice Address - Phone:314-543-3860
Practice Address - Fax:314-272-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy