Provider Demographics
NPI:1376893297
Name:RELIANT CARE REHABILITATIVE SERVICES
Entity type:Organization
Organization Name:RELIANT CARE REHABILITATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:PERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:314-524-6191
Mailing Address - Street 1:411 ROBERT AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-3526
Mailing Address - Country:US
Mailing Address - Phone:314-524-6191
Mailing Address - Fax:
Practice Address - Street 1:411 ROBERT AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-3526
Practice Address - Country:US
Practice Address - Phone:314-524-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116138313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility