Provider Demographics
NPI:1194994285
Name:FULLER REHABILITATION & CONSULTING SERVICES, INC.
Entity type:Organization
Organization Name:FULLER REHABILITATION & CONSULTING SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-965-0352
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-0615
Mailing Address - Country:US
Mailing Address - Phone:706-965-6131
Mailing Address - Fax:706-413-1353
Practice Address - Street 1:6149 WEDEKING AVE
Practice Address - Street 2:BLDG. D, SUITE 3
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8535
Practice Address - Country:US
Practice Address - Phone:812-479-8870
Practice Address - Fax:812-473-0020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULLER REHABILITATION & CONSULTING SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies