Healthcare Provider Details

I. General information

NPI: 1417458795
Provider Name (Legal Business Name): REHABCARE GROUP EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6806 43RD ST
LUBBOCK TX
79407
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 806-281-5600
  • Fax: 806-799-3714
Mailing address:
  • Phone: 502-596-7906
  • Fax: 502-596-4134

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: MR. TERRANCE K. DILLON
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7220