Provider Demographics
NPI:1265046346
Name:CHILDREN'S 1ST REHABILITATION CENTER, INC
Entity type:Organization
Organization Name:CHILDREN'S 1ST REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PHD
Authorized Official - Phone:404-723-5583
Mailing Address - Street 1:445 YOUNG JAMES CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1475
Mailing Address - Country:US
Mailing Address - Phone:404-723-5583
Mailing Address - Fax:
Practice Address - Street 1:239 VILLAGE CENTER PKWY STE 190
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9024
Practice Address - Country:US
Practice Address - Phone:404-723-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)