Provider Demographics
NPI:1104138361
Name:ABILITY REHAB, LLC
Entity type:Organization
Organization Name:ABILITY REHAB, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PRASANT
Authorized Official - Middle Name:H
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MPH
Authorized Official - Phone:678-298-9484
Mailing Address - Street 1:1835 SAVOY DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:678-298-9484
Mailing Address - Fax:678-826-4033
Practice Address - Street 1:1835 SAVOY DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1072
Practice Address - Country:US
Practice Address - Phone:678-298-9484
Practice Address - Fax:678-826-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-04
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPPT000791261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111721AMedicaid
GA202G709590OtherMEDICARE PTAN
GA704857OtherWELLCARE