Provider Demographics
NPI:1336511161
Name:REBUILD REHABILITATION
Entity Type:Organization
Organization Name:REBUILD REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JERMAAL
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:562-508-0429
Mailing Address - Street 1:10143 BRUSSELS LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0572
Mailing Address - Country:US
Mailing Address - Phone:562-508-0429
Mailing Address - Fax:
Practice Address - Street 1:10143 BRUSSELS LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0572
Practice Address - Country:US
Practice Address - Phone:562-508-0429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4021251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health