Basic Information
| Provider Information | |||||||||
| NPI: | 1174021695 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION HOSPITAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BURTON HILLS BLVD STE 250 | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152963000 | ||||||||
| FaxNumber: | 6152966227 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 OLYMPIC PLAZA CIR | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2018 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | PETROVICH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP | ||||||||
| AuthorizedOfficialTelephone: | 6152963000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AHS EAST TEXAS HEALTH SYSTEM LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC3500X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Cardiac Rehabilitation | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 283X00000X | Y | Hospitals | Rehabilitation Hospital |
No ID Information.