Provider Demographics
NPI:1336184738
Name:CMB REHABILITATION, INC.
Entity Type:Organization
Organization Name:CMB REHABILITATION, INC.
Other - Org Name:CAROL A. MEYER-BOLDON & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:BOLDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-784-4471
Mailing Address - Street 1:1314 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5616
Mailing Address - Country:US
Mailing Address - Phone:608-784-4471
Mailing Address - Fax:608-784-4953
Practice Address - Street 1:2400 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7619
Practice Address - Country:US
Practice Address - Phone:608-784-4471
Practice Address - Fax:608-784-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41221500Medicaid