Provider Demographics
NPI:1982772109
Name:DIXIE HOME REHAB LLC
Entity Type:Organization
Organization Name:DIXIE HOME REHAB LLC
Other - Org Name:DIXIE HOME REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOKANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-8347
Mailing Address - Street 1:393 E RIVERSIDE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7126
Mailing Address - Country:US
Mailing Address - Phone:435-628-8347
Mailing Address - Fax:435-628-3472
Practice Address - Street 1:393 E RIVERSIDE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7126
Practice Address - Country:US
Practice Address - Phone:435-628-8347
Practice Address - Fax:435-628-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health