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NPI Code Detail

MEDICARE: ADVANCE REHABILITATION FOR KIDS OF GORDON COUNTY, INC

MEDICARE: ADVANCE REHABILITATION FOR KIDS OF GORDON COUNTY, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0400XRehabilitation Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1903001OTHERGABCBSGA

General Provider Information

NPI Number : 1376513382
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCE REHABILITATION FOR KIDS OF GORDON COUNTY, INC
Provider Business Mailing Address
First Line : 365 S INDUSTRIAL BLVD
Second Line :
City : CALHOUN
State : GA
Zip : 30701-3075
Country : US
Telephone Number : 706-624-3000
Fax Number : 706-624-3001
Provider Business Practice Location Address
First Line : 365 S INDUSTRIAL BLVD
Second Line :
City : CALHOUN
State : GA
Zip : 30701-3075
Country : US
Telephone Number : 706-624-3000
Fax Number : 706-624-3001
Authorized Official
Title or Position : OFFICE MANAGER
Name : WENDY M BARTON
Credential :
Telephone Number : 706-624-3000
Provider Enumeration Date : 01/23/2006
Last Update Date : 02/16/2011

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