Provider Demographics
NPI:1538556311
Name:REHABILITATION CENTERS, INC., D/B/A MILLCREEK OF PONTOTOC
Entity type:Organization
Organization Name:REHABILITATION CENTERS, INC., D/B/A MILLCREEK OF PONTOTOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-488-8878
Mailing Address - Street 1:1814 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-6962
Mailing Address - Country:US
Mailing Address - Phone:662-488-8878
Mailing Address - Fax:662-488-8767
Practice Address - Street 1:1814 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-6962
Practice Address - Country:US
Practice Address - Phone:662-488-8878
Practice Address - Fax:662-488-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS911302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00220588Medicaid