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NPI Code Detail

MEDICARE: GRACE REHABILITATION CENTER, INC.

MEDICARE: GRACE REHABILITATION CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)446655TN

General Provider Information

NPI Number : 1659485936
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE REHABILITATION CENTER, INC.
Provider Business Mailing Address
First Line : 2435 JACKSBORO PIKE
Second Line :
City : LA FOLLETTE
State : TN
Zip : 37766-2910
Country : US
Telephone Number : 423-566-2250
Fax Number : 423-566-5896
Provider Business Practice Location Address
First Line : 2435 JACKSBORO PIKE
Second Line :
City : LA FOLLETTE
State : TN
Zip : 37766-2910
Country : US
Telephone Number : 423-566-2250
Fax Number : 423-566-5896
Authorized Official
Title or Position : PRESIDENT
Name : BRIAN W LEACH
Credential : M.B.S
Telephone Number : 423-566-2250
Provider Enumeration Date : 08/17/2006
Last Update Date : 10/09/2018

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Directions to “GRACE REHABILITATION CENTER, INC. ” Practice Location

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