Enliven Rehabilitation Services LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ENLIVEN REHABILITATION SERVICES LLC

Practice address

2189 Silas Deane Hwy
Rocky Hill, CT 06067-2324

Phone

(860) 900-0174

NPI assigned

Aug 2, 2019

Last updated

Aug 2, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

ENLIVEN REHABILITATION SERVICES LLCAs reported in NPPES

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

Authorized official

Name

Brian C Goode

Title

Ceo

Phone

(603) 490-9725

Specialties & licenses 2

Addresses

Electronic endpoints 1

Tax ID family

Enliven Rehabilitation Services LLC3 organizations share this tax ID, including this one

Part of

Enliven Rehabilitation Services LLC

Other organizations with this tax ID 2

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

• Enliven Rehabilitation Services LLC

  • Physical Therapist
  • Amesbury, MA
  • NPI 1356996797
  NPD tax ID
• Enliven Rehabilitation Services LLC

  • Physical Therapist
  • Gahanna, OH
  • NPI 1386202554
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica Mahoney, OT

  • Occupational Therapist
  • Rocky Hill, CT
  • NPI 1114687159
  NPD

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564704000000",
    "number": "1255986691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2189 SILAS DEANE HWY",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060672324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2189 SILAS DEANE HWY",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060672324",
            "telephone_number": "860-900-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENLIVEN REHABILITATION SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENLIVEN REHABILITATION SERVICES LLC",
        "enumeration_date": "2019-08-02",
        "last_updated": "2019-08-02",
        "status": "A",
        "authorized_official_last_name": "GOODE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "603-490-9725"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bgoode@ccbainc.com",
            "affiliation": "N",
            "address_1": "2189 Silas Deane Hwy",
            "city": "Rocky Hill",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060672324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Rocky Hill, CT
• Providers in Rocky Hill, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; 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.