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General NPI Number Information
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NPI Number | 1336497833
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Entity Type | Organization
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Legal Business Name | RELIANT CARE REHABILITATION SERVICES
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 2011 CORONA RD SUITE 301
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City | COLUMBIA
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State | MO
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Zip | 65203-2548
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Country | US
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Telephone | 314-543-3861
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Fax |
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Provider Business Mailing Address
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Address Line | 112 CARRINGTON CT APT A
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City | GLEN CARBON
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State | IL
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Zip | 62034-2991
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | CIERRA BROWN
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Credential |
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Telephone | 618-530-7462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2012016487
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License Number State | MO
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