Provider Demographics
NPI:1104170059
Name:RELIVE REHAB GROUP
Entity type:Organization
Organization Name:RELIVE REHAB GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISIONAL VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-295-4591
Mailing Address - Street 1:2020 N TYLER RD STE 112
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4916
Mailing Address - Country:US
Mailing Address - Phone:316-295-4591
Mailing Address - Fax:316-295-4713
Practice Address - Street 1:2020 N TYLER RD STE 112
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4916
Practice Address - Country:US
Practice Address - Phone:316-295-4591
Practice Address - Fax:316-295-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS84221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty