Provider Demographics
NPI:1932101946
Name:FIRSTCARE REHABILITATION, INC.
Entity Type:Organization
Organization Name:FIRSTCARE REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:BRAND
Authorized Official - Last Name:HARTSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-323-1682
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0334
Mailing Address - Country:US
Mailing Address - Phone:580-323-1682
Mailing Address - Fax:580-323-1711
Practice Address - Street 1:1725 S HIGHWAY 183
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9533
Practice Address - Country:US
Practice Address - Phone:580-323-1682
Practice Address - Fax:580-323-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2120261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100745510AMedicaid
OK100745510AMedicaid