Provider Demographics
NPI:1700146628
Name:PATRIOT REHABILITATION, LLC
Entity type:Organization
Organization Name:PATRIOT REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & PRINCIPAL CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CRC
Authorized Official - Phone:816-560-3227
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-0204
Mailing Address - Country:US
Mailing Address - Phone:816-560-3227
Mailing Address - Fax:816-625-1147
Practice Address - Street 1:1605 SE HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9406
Practice Address - Country:US
Practice Address - Phone:816-560-3227
Practice Address - Fax:816-625-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management