Provider Demographics
NPI:1649913120
Name:ELITE REHAB HOLTVILLE LLC
Entity type:Organization
Organization Name:ELITE REHAB HOLTVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAN ETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-799-5853
Mailing Address - Street 1:213 LIGHTWOOD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022
Mailing Address - Country:US
Mailing Address - Phone:334-543-4269
Mailing Address - Fax:334-543-4272
Practice Address - Street 1:213 LIGHTWOOD RD STE 2
Practice Address - Street 2:
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022
Practice Address - Country:US
Practice Address - Phone:334-543-4269
Practice Address - Fax:334-543-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty