Healthcare Provider Details

I. General information

NPI: 1245766005
Provider Name (Legal Business Name): NEURO REHABCARE OF HAMMOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41238 ADAMS RD
HAMMOND LA
70403-2069
US

IV. Provider business mailing address

9201 PARALLEL PKWY
KANSAS CITY KS
66112-1510
US

V. Phone/Fax

Practice location:
  • Phone: 913-334-4110
  • Fax: 913-334-3121
Mailing address:
  • Phone: 913-334-4110
  • Fax: 913-334-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: LISA DOUTHITT
Title or Position: CREDENTIALING & BILLING SPECIALIST
Credential:
Phone: 913-334-4110