# TRI-VISTA REHAB, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TriVista Rehab at Riverbirch Residence
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386240893
- **Authorized official:** KEVIN BOUTIN OTR (PRESIDENT)
- **Authorized official phone:** (662) 840-0535

## Contact information

- **Practice address:** 2554 MAIN ST, PLANTERSVILLE, MS 38862-7908
- **Practice address phone:** (662) 407-0301
- **Practice address fax:** (662) 842-7915
- **Mailing address:** PO BOX 3592, TUPELO, MS 38803-3592
- **Mailing address phone:** (662) 407-0301
- **Mailing address fax:** (662) 842-7915

## Taxonomy

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

## Other

- **Enumeration date:** 12/09/2020
- **Last updated:** 12/09/2020