Provider Demographics
NPI:1922057942
Name:REHAB OUTREACH, L.L.C.
Entity Type:Organization
Organization Name:REHAB OUTREACH, L.L.C.
Other - Org Name:RENAISSANCE THERAPY OF HERMANN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DULLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-506-8800
Mailing Address - Street 1:2127 INNERBELT BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5700
Mailing Address - Country:US
Mailing Address - Phone:314-506-8800
Mailing Address - Fax:314-506-8880
Practice Address - Street 1:2064 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-1592
Practice Address - Country:US
Practice Address - Phone:573-486-1600
Practice Address - Fax:573-486-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH0000Medicare UPIN
MO266657Medicare PIN