Healthcare Provider Details

I. General information

NPI: 1194761601
Provider Name (Legal Business Name): REHAB OUTREACH, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S MADISON ST
MALDEN MO
63863-2462
US

IV. Provider business mailing address

2127 INNERBELT BUSINESS CENTER DR SUITE 107
SAINT LOUIS MO
63114-5700
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-4999
  • Fax: 573-276-5084
Mailing address:
  • Phone: 314-506-8800
  • Fax: 314-506-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CATHERINE A DULLE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 314-506-8800