Provider Demographics
NPI:1871239228
Name:MOBILITY REHAB LLC
Entity type:Organization
Organization Name:MOBILITY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-573-9974
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-1227
Mailing Address - Country:US
Mailing Address - Phone:601-573-9974
Mailing Address - Fax:601-487-8546
Practice Address - Street 1:1550 E UNIVERSITY DR APT 224
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6368
Practice Address - Country:US
Practice Address - Phone:601-573-9974
Practice Address - Fax:601-487-8546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBILITY REHAB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation