Provider Demographics
NPI:1780066498
Name:MAINSTREAM REHABILITATIVE SERVICES LLC
Entity type:Organization
Organization Name:MAINSTREAM REHABILITATIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-359-6235
Mailing Address - Street 1:112 SENTINEL RDG
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-8280
Mailing Address - Country:US
Mailing Address - Phone:864-359-6235
Mailing Address - Fax:866-801-5332
Practice Address - Street 1:112 SENTINEL RDG
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-8280
Practice Address - Country:US
Practice Address - Phone:864-359-6235
Practice Address - Fax:866-801-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health