Provider Demographics
NPI:1861228512
Name:JENNERATIONAL REHAB LLC
Entity type:Organization
Organization Name:JENNERATIONAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:JADICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-445-3391
Mailing Address - Street 1:4638 BIT AND SPUR RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2646
Mailing Address - Country:US
Mailing Address - Phone:251-699-0295
Mailing Address - Fax:251-699-0295
Practice Address - Street 1:4638 BIT AND SPUR RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2646
Practice Address - Country:US
Practice Address - Phone:251-699-0295
Practice Address - Fax:251-699-0295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNERATIONAL REHAB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty