NPIMap

Organization Active NPI

Tri-Vista Rehab, Inc

  • Assisted Living Facility
  • Tupelo, MS
National Provider Identifier
1144577339
Registry record updated Sep 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
PT4554 Issued in MS
Legal business name
TRI-VISTA REHAB, INC
Practice address
90A Clark Blvd
Tupelo, MS 38804-2801
Phone
(662) 840-0535
Fax
(662) 842-7915
NPI assigned
Aug 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kevin Troy Boutin, OTRNPI 1780740456
Title
President
Phone
(662) 840-0535

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X PT4554 MS Primary

Addresses

Primary practice location

90A Clark Blvd
Tupelo, MS 38804-2801

Mailing address

90A Clark Blvd
Tupelo, MS 38804-2801
Phone (662) 840-0535

National Provider Directory

National Provider Directory
Tax ID family
Trivista Rehab Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348617600000",
    "number": "1144577339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90A CLARK BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388042801",
            "telephone_number": "662-840-0535",
            "fax_number": "662-842-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90A CLARK BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388042801",
            "telephone_number": "662-840-0535",
            "fax_number": "662-842-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-VISTA REHAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2012-09-26",
        "status": "A",
        "authorized_official_last_name": "BOUTIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "TROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-840-0535",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MS",
            "license": "PT4554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.