Healthcare Provider Details

I. General information

NPI: 1306589890
Provider Name (Legal Business Name): JOHNSON COUNTY REHABILITATION HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11325 COLLEGE BOULEVARD
OVERLAND PARK KS
66210
US

IV. Provider business mailing address

450 CENTURY PKWY STE 220
ALLEN TX
75013-8135
US

V. Phone/Fax

Practice location:
  • Phone: 480-801-6700
  • Fax:
Mailing address:
  • Phone: 469-640-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: TRACEY NIXON
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 469-640-6503