Healthcare Provider Details

I. General information

NPI: 1629136437
Provider Name (Legal Business Name): PERRY COUNTY REHAB & DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DR MIKE CLOUSE DRIVE
SOMERSET OH
43783
US

IV. Provider business mailing address

2405 N COLUMBUS ST SUITE 140
LANCASTER OH
43130-8185
US

V. Phone/Fax

Practice location:
  • Phone: 740-743-3800
  • Fax: 740-743-3900
Mailing address:
  • Phone: 740-743-3800
  • Fax: 740-743-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY EDWARD KORDACK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-687-0036