Provider Demographics
NPI:1053414177
Name:INTEGRA REHABILITATION AGENCY, LLC
Entity type:Organization
Organization Name:INTEGRA REHABILITATION AGENCY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:SHOOP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:866-261-8090
Mailing Address - Street 1:1013 RIVERBURCH PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8887
Mailing Address - Country:US
Mailing Address - Phone:706-278-4438
Mailing Address - Fax:706-226-7869
Practice Address - Street 1:1013 RIVERBURCH PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8887
Practice Address - Country:US
Practice Address - Phone:706-278-4438
Practice Address - Fax:706-226-7869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY REHABILITATION SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation