Provider Demographics
NPI:1447439070
Name:COMMUNITY REHAB OF GREENVILLE INC
Entity type:Organization
Organization Name:COMMUNITY REHAB OF GREENVILLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAYARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-832-8327
Mailing Address - Street 1:11010 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3481
Mailing Address - Country:US
Mailing Address - Phone:228-832-8327
Mailing Address - Fax:228-832-8328
Practice Address - Street 1:11010 DAVID ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3481
Practice Address - Country:US
Practice Address - Phone:228-832-8327
Practice Address - Fax:228-832-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty