Provider Demographics
NPI:1811343916
Name:PURE REHABILITATION LLC
Entity type:Organization
Organization Name:PURE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFFNER-SZYNSKIE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:712-542-0123
Mailing Address - Street 1:201 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-0000
Mailing Address - Country:US
Mailing Address - Phone:712-850-1348
Mailing Address - Fax:712-850-1349
Practice Address - Street 1:201 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-0000
Practice Address - Country:US
Practice Address - Phone:712-850-1348
Practice Address - Fax:712-850-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
IA01433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1982732418OtherOWNER NPI