Healthcare Provider Details

I. General information

NPI: 1336497833
Provider Name (Legal Business Name): RELIANT CARE REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CORONA RD SUITE 301
COLUMBIA MO
65203-2548
US

IV. Provider business mailing address

112 CARRINGTON CT APT A
GLEN CARBON IL
62034-2991
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-3861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2012016487
License Number StateMO

VIII. Authorized Official

Name: CIERRA BROWN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 618-530-7462