Provider Demographics
| NPI: | 1003966748 |
|---|---|
| Name: | REDWOOD SCHOOL AND REHABILITATION CENTER |
| Entity type: | Organization |
| Organization Name: | REDWOOD SCHOOL AND REHABILITATION CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | PAM |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GREEN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 859-331-0880 |
| Mailing Address - Street 1: | 71 ORPHANAGE RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FT MITCHELL |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 41017-3006 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 859-331-0880 |
| Mailing Address - Fax: | 859-331-6177 |
| Practice Address - Street 1: | 71 ORPHANAGE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | FT MITCHELL |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 41017-3006 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 859-331-0880 |
| Practice Address - Fax: | 855-704-1573 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-01-12 |
| Last Update Date: | 2023-06-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QH0700X | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 261QM3000X | Ambulatory Health Care Facilities | Clinic/Center | Medically Fragile Infants and Children Day Care | Group - Multi-Specialty |
| Yes | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child | Group - Multi-Specialty |
| Yes | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | Group - Multi-Specialty |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 45335650 | Medicaid |
