Healthcare Provider Details

I. General information

NPI: 1528095452
Provider Name (Legal Business Name): REHAB COLORADO, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 AIRPORT ROAD
BRECKENRIDGE CO
80424
US

IV. Provider business mailing address

4714 GETTYSBURG RD
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 970-453-4365
  • Fax: 970-453-7972
Mailing address:
  • Phone: 717-975-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E. TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1132