Healthcare Provider Details

I. General information

NPI: 1003375411
Provider Name (Legal Business Name): NEURO REHABCARE-TASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 HARMONY ROAD
CRYSTAL SPRINGS MS
39059
US

IV. Provider business mailing address

512 HARMONY ROAD
CRYSTAL SPRINGS MS
39059
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-4384
  • Fax: 601-892-4386
Mailing address:
  • Phone: 601-892-4384
  • Fax: 601-892-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF STANFORD
Title or Position: DIRECTOR
Credential: M.A.
Phone: 601-892-4384