Provider Demographics
NPI:1811092406
Name:CLUB REHAB, INC.
Entity type:Organization
Organization Name:CLUB REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-329-7744
Mailing Address - Street 1:73-5590 KAUHOLA ST STE A
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2610
Mailing Address - Country:US
Mailing Address - Phone:808-329-7744
Mailing Address - Fax:808-334-1608
Practice Address - Street 1:73-5590 KAUHOLA ST STE A
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2610
Practice Address - Country:US
Practice Address - Phone:808-329-7744
Practice Address - Fax:808-334-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH53181Medicare PIN