Provider Demographics
NPI:1194337212
Name:ACCIDENT AND INJURY REHAB CENTER, INC
Entity type:Organization
Organization Name:ACCIDENT AND INJURY REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:VON-SCHILLING WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACAN, FIACN
Authorized Official - Phone:262-770-7014
Mailing Address - Street 1:PO BOX 44398
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-7007
Mailing Address - Country:US
Mailing Address - Phone:414-433-0433
Mailing Address - Fax:
Practice Address - Street 1:6114 W CAPITOL DR STE 100-102
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2147
Practice Address - Country:US
Practice Address - Phone:414-433-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center