Healthcare Provider Details

I. General information

NPI: 1992842058
Provider Name (Legal Business Name): REHAB SPECIALTY MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 HEISINGER RD UNIT F
JEFFERSON CITY MO
65109-4791
US

IV. Provider business mailing address

PO BOX 105602
JEFFERSON CITY MO
65110
US

V. Phone/Fax

Practice location:
  • Phone: 800-386-8279
  • Fax:
Mailing address:
  • Phone: 800-386-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number19184786
License Number StateMO

VIII. Authorized Official

Name: MR. JASON F FORREST
Title or Position: PRESIDENT
Credential:
Phone: 800-386-8279