Provider Demographics
NPI:1558452920
Name:BODALIA REHAB SERVICES, INC
Entity type:Organization
Organization Name:BODALIA REHAB SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BODALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-747-4118
Mailing Address - Street 1:18601 E SILVERHILL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-3703
Mailing Address - Country:US
Mailing Address - Phone:251-747-4118
Mailing Address - Fax:251-947-2697
Practice Address - Street 1:18601 E SILVERHILL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-3703
Practice Address - Country:US
Practice Address - Phone:251-747-4118
Practice Address - Fax:251-947-2697
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODALIA REHAB SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51046794OtherBCBS OF AL
ALI951OtherMEDICARE LEGACY #
AL51046794OtherBCBS OF AL
AL000046794Medicare PIN