Provider Demographics
NPI:1245351725
Name:REDEEMED REHABILITATIVE CARE SERVICES, INCORPORATED
Entity type:Organization
Organization Name:REDEEMED REHABILITATIVE CARE SERVICES, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLADOSU
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIOYE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:219-769-1358
Mailing Address - Street 1:P.O. BOX 14322
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-4322
Mailing Address - Country:US
Mailing Address - Phone:219-769-1358
Mailing Address - Fax:219-769-1383
Practice Address - Street 1:7870 BROADWAY STE N
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5542
Practice Address - Country:US
Practice Address - Phone:219-769-1358
Practice Address - Fax:219-769-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007247A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200855540AMedicaid
IN250900Medicare PIN