Provider Demographics
NPI:1356728190
Name:REHAB AT HOME LLC
Entity type:Organization
Organization Name:REHAB AT HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-597-3335
Mailing Address - Street 1:1370 N FAIRFIELD RD
Mailing Address - Street 2:STE B
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1370 N FAIRFIELD RD
Practice Address - Street 2:STE B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2675
Practice Address - Country:US
Practice Address - Phone:937-597-6681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH369151Medicare Oscar/Certification