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General NPI Number Information
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NPI Number | 1679857585
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Entity Type | Organization
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Legal Business Name | MBRH LLC
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 101 VILLA DR
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City | DAPHNE
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State | AL
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Zip | 36526-4653
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Country | US
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Telephone | 251-621-4354
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Fax | 251-621-4331
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Provider Business Mailing Address
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Address Line | 101 VILLA DR
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City | DAPHNE
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State | AL
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Zip | 36526-4653
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Country | US
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Telephone | 251-621-4354
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Fax | 251-621-4331
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Authorized Official
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Title or Position | PRESIDENT&TREASURER, SE HEALTHCARE
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Name | MR. ARNOLD HEINEMANN
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Credential |
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Telephone | 845-746-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | H0204
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License Number State | AL
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