Provider Demographics
NPI:1205346111
Name:REHABILITATION NETWORK OUTPATIENT SERVICES LLC
Entity type:Organization
Organization Name:REHABILITATION NETWORK OUTPATIENT SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MRC, CRC
Authorized Official - Phone:501-548-6003
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0202
Mailing Address - Country:US
Mailing Address - Phone:501-548-6003
Mailing Address - Fax:844-209-1709
Practice Address - Street 1:93 RODEN MILL RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-9555
Practice Address - Country:US
Practice Address - Phone:479-858-2760
Practice Address - Fax:479-858-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221336742Medicaid