Provider Demographics
NPI:1386948040
Name:BODALIA REHAB SERVICES, INC
Entity type:Organization
Organization Name:BODALIA REHAB SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEHAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BODALIA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:251-747-4118
Mailing Address - Street 1:18601 E SILVERHILL AVE
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-3703
Mailing Address - Country:US
Mailing Address - Phone:251-747-4118
Mailing Address - Fax:877-232-9875
Practice Address - Street 1:1721 N BUNNER ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2229
Practice Address - Country:US
Practice Address - Phone:251-279-8094
Practice Address - Fax:800-957-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS96400Medicare UPIN