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General NPI Number Information
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NPI Number | 1760420327
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED REHAB SERVICES, LLC
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 429 S BLANCHE ST SUITE 210
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City | MOUNDS
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State | IL
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Zip | 62964-1107
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Country | US
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Telephone | 618-745-9419
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Fax | 618-745-9421
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Provider Business Mailing Address
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Address Line | 101 PARK CIR
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City | BENTON
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State | IL
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Zip | 62812-3464
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Country | US
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Telephone | 618-534-9678
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Fax | 618-435-2346
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Authorized Official
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Title or Position | OWNER
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Name | MR. BENJAMIN N RICE
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Credential |
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Telephone | 618-534-9678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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