Organization
SELECT REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MICHAEL LEON SULLIVAN (PTA)
(417) 840-1588
Entity
Organization
Contact information
Practice address
1707 W ELFINDALE ST, SPRINGFIELD, MO 65807-1246
(417) 831-2273
(417) 831-7409
Mailing address
2180 S FORREST HEIGHTS AVE, SPRINGFIELD, MO 65809-2971
(417) 840-1588
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
116911
MO
314000000X
Skilled Nursing Facility
Primary
116911
MO
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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