# TRI-VISTA REHAB, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TRI-VISTA REHAB, INC
- **Other names:** TriVista Rehab at Community Development Inc.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1265025522
- **Legal business name:** TRI-VISTA REHAB, INC
- **Authorized official:** KEVIN BOUTIN OTR (PRESIDENT)
- **Authorized official phone:** (662) 840-0535

## Contact information

- **Practice address:** 411 OAK ST., RICHTON, MS 39476
- **Practice address phone:** (662) 270-6486
- **Practice address fax:** (662) 842-7915
- **Mailing address:** PO BOX 3592, TUPELO, MS 38803-3592
- **Mailing address phone:** (662) 840-0535
- **Mailing address fax:** (662) 842-7915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/18/2021
- **Last updated:** 02/18/2021