Provider Demographics
NPI:1013247774
Name:ARK REHAB, P.S.C.
Entity Type:Organization
Organization Name:ARK REHAB, P.S.C.
Other - Org Name:ARK REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:859-543-9463
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-543-9463
Mailing Address - Fax:859-543-2063
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:SUITE 16
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-543-9463
Practice Address - Fax:859-543-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency