Provider Demographics
NPI:1295274827
Name:PREMIER REHAB, INC.
Entity type:Organization
Organization Name:PREMIER REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-784-4704
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0541
Mailing Address - Country:US
Mailing Address - Phone:423-784-4704
Mailing Address - Fax:423-784-1865
Practice Address - Street 1:980 LONE RD
Practice Address - Street 2:
Practice Address - City:PIONEER
Practice Address - State:TN
Practice Address - Zip Code:37847-4236
Practice Address - Country:US
Practice Address - Phone:423-784-4704
Practice Address - Fax:423-784-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000900261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation