MEDICARE: NOVACARE OUTPATIENT REHABILITATION EAST 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1699946061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVACARE OUTPATIENT REHABILITATION EAST INC

Provider Business Mailing Address
First Line	:	4716 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	8511 JEFFERSON LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2121
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL TARVIN
Credential	:
Telephone Number	:	717-975-4503

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	03/14/2008

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