Provider Demographics
NPI:1104987684
Name:FULL RANGE REHAB LLC
Entity type:Organization
Organization Name:FULL RANGE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY AND COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-330-5995
Mailing Address - Street 1:9010 GOLDPARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9764
Mailing Address - Country:US
Mailing Address - Phone:513-330-5995
Mailing Address - Fax:800-819-7985
Practice Address - Street 1:9010 GOLDPARK DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45011-9764
Practice Address - Country:US
Practice Address - Phone:513-330-5995
Practice Address - Fax:800-819-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7463860001Medicaid