=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588916068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MB INVESTORS DBA CATERRA HEALTH SYSTEMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2012
-----------------------------------------------------
Last Update Date | 10/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 931 SOUTH THIRD STREET
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-561-6431
-----------------------------------------------------
Fax | 502-561-6432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 931 S. THIRD STREET
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-561-6431
-----------------------------------------------------
Fax | 502-561-6432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | WENDY ANDERSON
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 502-561-6431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number | 101132
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------