Provider Demographics
NPI:1639502321
Name:RYDERS REHABILITATION, LLC
Entity type:Organization
Organization Name:RYDERS REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHABILITATION
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RACCIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PTA, MS, LNHA
Authorized Official - Phone:203-870-2022
Mailing Address - Street 1:999 ORONOQUE LN
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1379
Mailing Address - Country:US
Mailing Address - Phone:203-870-2022
Mailing Address - Fax:203-386-1144
Practice Address - Street 1:999 ORONOQUE LN
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1379
Practice Address - Country:US
Practice Address - Phone:203-870-2022
Practice Address - Fax:203-386-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT225100000XOtherTAXONOMY
CT225100000XOtherTAXONOMY