Healthcare Provider Details

I. General information

NPI: 1255448775
Provider Name (Legal Business Name): REHABILITATION CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 HWY 15 NORTH
PONTOTOC MS
38863
US

IV. Provider business mailing address

PO BOX 619
PONTOTOC MS
38863-0619
US

V. Phone/Fax

Practice location:
  • Phone: 662-488-8878
  • Fax: 662-488-8767
Mailing address:
  • Phone: 662-488-8878
  • Fax: 662-488-8767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number911
License Number StateMS

VIII. Authorized Official

Name: CHRISTOPHER HOWARD
Title or Position: VP AND SECRETARY
Credential:
Phone: 615-861-6000