Healthcare Provider Details

I. General information

NPI: 1285958116
Provider Name (Legal Business Name): PROSTEP REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORFLEET DR
SOMERSET KY
42501-1952
US

IV. Provider business mailing address

200 NORFLEET DR
SOMERSET KY
42501-1952
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-5104
  • Fax: 606-677-1925
Mailing address:
  • Phone: 606-678-5104
  • Fax: 606-677-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA02524
License Number StateKY

VIII. Authorized Official

Name: MS. CAMELLIA G HUFF
Title or Position: FACILITY REHAB COORDINATOR
Credential: SLP
Phone: 606-678-5104