1720677503 NPI number — HUMAN PERFORMANCE AND REHABILITATION CENTERS, LLC

Table of content: (NPI 1720677503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720677503 NPI number — HUMAN PERFORMANCE AND REHABILITATION CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMAN PERFORMANCE AND REHABILITATION CENTERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720677503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31908-8068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2140 E UNIVERSITY DR STE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36830-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-321-0601
Provider Business Practice Location Address Fax Number:
334-321-0605
Provider Enumeration Date:
01/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLUSKEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/MEMBER
Authorized Official Telephone Number:
706-322-7762

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com