Healthcare Provider Details

I. General information

NPI: 1336577048
Provider Name (Legal Business Name): REHABCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N GRAND AVE
DONIPHAN MO
63935-1779
US

IV. Provider business mailing address

1015 N GRAND AVE
DONIPHAN MO
63935-1779
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-4239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2007006282
License Number StateMO

VIII. Authorized Official

Name: AMANDA LEROUX
Title or Position: SPEACH PATHOLOGIST
Credential: MCDCCC-SLP
Phone: 573-429-2675