Provider Demographics
NPI:1669425823
Name:REHABCARE GROUP EAST, LLC
Entity type:Organization
Organization Name:REHABCARE GROUP EAST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:3390 ANNAPOLIS LN N STE B
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5379
Mailing Address - Country:US
Mailing Address - Phone:763-767-0854
Mailing Address - Fax:763-862-6533
Practice Address - Street 1:3390 ANNAPOLIS LN N STE B
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5379
Practice Address - Country:US
Practice Address - Phone:763-767-0854
Practice Address - Fax:763-862-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN545755600Medicaid
MN545755600Medicaid
246509Medicare Oscar/Certification