Basic Information
Provider Information | |||||||||
NPI: | 1275526725 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ADULT SERVICES UNLIMITED, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | RIVERSIDE REHABILITATION CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 111 WEST MICHIGAN STREET | ||||||||
Address2: |   | ||||||||
City: | MILWAUKEE | ||||||||
State: | WI | ||||||||
PostalCode: | 532032903 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4149088119 | ||||||||
FaxNumber: | 4149087105 | ||||||||
Practice Location | |||||||||
Address1: | 220 S. RIVER STREET | ||||||||
Address2: |   | ||||||||
City: | PLAINS | ||||||||
State: | PA | ||||||||
PostalCode: | 187051137 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5708243444 | ||||||||
FaxNumber: | 5708244021 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2005 | ||||||||
LastUpdateDate: | 07/06/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CARTER | ||||||||
AuthorizedOfficialFirstName: | ROCH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 4149088221 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 225100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 42659 | 01 | PA | GEISINGER | OTHER | 50013006 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 1463894 | 05 | PA |   | MEDICAID | 01903276 | 05 | PA |   | MEDICAID | 372927 | 01 | PA | BLUE SHIELD | OTHER | 538523 | 01 | PA | AETNA US HEALTHCARE | OTHER | 815236 | 01 | PA | FIRST PRIORITY HEALTH | OTHER |