Organization
CARTHAGE REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP CODY LONG (VICE PRESIDENT)
(205) 391-3600
Entity
Organization
Contact information
Practice address
1901A BUENA VISTA AVE, CARTHAGE, MO 64836-3178
(417) 358-3440
(417) 359-5617
Mailing address
1901A BUENA VISTA AVE, CARTHAGE, MO 64836-3178
(417) 358-3440
(417) 359-5617
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
572480903
—
MO
Enumeration date
01/22/2007
Last updated
10/12/2020
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