Contract Details
Ancillary Care Services
Facility name
RehabClinics
Provider ID
P000004048
NPI
1225033202
Tax ID
232736153
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
3391 Airport Road
Portage, IN 46368
United States
County
Porter
Phone
2197620821 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address