Healthcare Provider Details

I. General information

NPI: 1669865788
Provider Name (Legal Business Name): ENCORE REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 SUNSCOPE DR
OCEAN SPRINGS MS
39564-8690
US

IV. Provider business mailing address

6520 SUNSCOPE DR
OCEAN SPRINGS MS
39564-8690
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-1177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY B CLARK
Title or Position: DIRECTOR OF REHAB
Credential: LPTA
Phone: 228-875-1177