Provider Demographics
NPI:1801118351
Name:REHAB & INDUSTRIAL SERVICES
Entity type:Organization
Organization Name:REHAB & INDUSTRIAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-748-2086
Mailing Address - Street 1:325 HANSON ST
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3607
Mailing Address - Country:US
Mailing Address - Phone:775-748-2086
Mailing Address - Fax:775-748-2087
Practice Address - Street 1:925 NORTH WELLS AVENUE
Practice Address - Street 2:UNIT B
Practice Address - City:WEST WENDOVER
Practice Address - State:NV
Practice Address - Zip Code:89883
Practice Address - Country:US
Practice Address - Phone:775-664-4144
Practice Address - Fax:775-664-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502503Medicaid
NV100502503Medicaid