Provider Demographics
NPI:1467669226
Name:RADICAL REHAB SOLUTIONS, LLC
Entity type:Organization
Organization Name:RADICAL REHAB SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:PHIFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-781-2510
Mailing Address - Street 1:PO BOX 6456
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25772-6456
Mailing Address - Country:US
Mailing Address - Phone:304-781-2510
Mailing Address - Fax:304-525-3311
Practice Address - Street 1:314 9TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1436
Practice Address - Country:US
Practice Address - Phone:304-781-2510
Practice Address - Fax:304-525-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1700045600Medicaid
WV03810OtherW V WORKER'S COMP