Organization
COMPREHENSIVE REHABILITATION OF LAFAYETTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BUFFY S ROARK PT (PRESIDENT)
(615) 666-5095
Entity
Organization
Contact information
Practice address
505 ELLINGTON DR STE A, LAFAYETTE, TN 37083-1074
(615) 666-5095
(615) 802-6194
Mailing address
PO BOX 629, LAFAYETTE, TN 37083-0629
(615) 666-5095
(615) 666-2254
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0446520
—
TN
01
—
37567
BCBS OF TN
TN
Enumeration date
07/01/2005
Last updated
05/10/2022
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