Provider Demographics
NPI:1750335808
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 1:4301 NW 63RD STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1549
Mailing Address - Country:US
Mailing Address - Phone:405-858-8737
Mailing Address - Fax:405-879-0247
Practice Address - Street 1:4301 NW 63RD ST
Practice Address - Street 2:SUITE 304
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-858-8737
Practice Address - Fax:405-879-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
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
OK200100810AMedicaid
OK376588Medicare Oscar/Certification