Healthcare Provider Details

I. General information

NPI: 1639137128
Provider Name (Legal Business Name): EFFINGHAM REHAB SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 TOWNE PARK DR STE 400
RINCON GA
31326
US

IV. Provider business mailing address

1110 SHAWNEE RD STE 206
LIMA OH
45805-3529
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-3797
  • Fax: 912-826-9767
Mailing address:
  • Phone: 141-922-1671
  • Fax: 912-826-9767

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: MR. BRAD C. ROUSH
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 419-221-6712