Provider Demographics
NPI:1194991323
Name:CENTENNIAL REHAB CENTER LLC
Entity type:Organization
Organization Name:CENTENNIAL REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-779-7969
Mailing Address - Street 1:8200 S QUEBEC ST
Mailing Address - Street 2:SUITE A3, BOX 150
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4411
Mailing Address - Country:US
Mailing Address - Phone:303-779-7969
Mailing Address - Fax:303-779-1501
Practice Address - Street 1:8100 S QUEBEC ST
Practice Address - Street 2:SUITE B17
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4408
Practice Address - Country:US
Practice Address - Phone:303-779-7969
Practice Address - Fax:303-779-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty