Provider Demographics
NPI:1871809061
Name:INTEGRATED REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:INTEGRATED REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:603-539-5351
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03864-0297
Mailing Address - Country:US
Mailing Address - Phone:603-539-5351
Mailing Address - Fax:603-539-3531
Practice Address - Street 1:1230 ROUTE 16
Practice Address - Street 2:HODSDON FARM BUILDING
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864-0297
Practice Address - Country:US
Practice Address - Phone:603-539-5351
Practice Address - Fax:603-539-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH656261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30390697Medicaid
NHRE 5666Medicare UPIN