Provider Demographics
NPI:1255440517
Name:REHABILITATION SERVICES OF COFFEE, INC
Entity type:Organization
Organization Name:REHABILITATION SERVICES OF COFFEE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:912-383-0559
Mailing Address - Street 1:PO BOX 2150
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-2150
Mailing Address - Country:US
Mailing Address - Phone:912-383-0559
Mailing Address - Fax:912-383-0614
Practice Address - Street 1:808 WARD ST W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3514
Practice Address - Country:US
Practice Address - Phone:912-383-0559
Practice Address - Fax:912-383-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA1122OtherRR MEDICARE
GA300031614AMedicaid
GADA1122OtherRR MEDICARE