NPIMap

Organization Active NPI

Tri-Vista Rehab, Inc

Doing business as TriVista Rehab at Community Development Inc.

  • Rehabilitation Clinic/Center
  • Richton, MS
National Provider Identifier
1265025522
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
TRI-VISTA REHAB, INC
Doing business as
TriVista Rehab at Community Development Inc.
Practice address
411 Oak St.
Richton, MS 39476
Phone
(662) 270-6486
Fax
(662) 842-7915
NPI assigned
Feb 18, 2021
Last updated
Feb 18, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
TRI-VISTA REHAB, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

Name
Kevin 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
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

411 Oak St.
Richton, MS 39476

Mailing address

PO Box 3592
Tupelo, MS 38803-3592
Phone (662) 840-0535

Other names 1

  • TriVista Rehab at Community Development Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210809001459 MS Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 0345390308 Practice locations: Richton, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265025522. Details of each certification follow.

  • CCN 256618 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 256618

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
TRI VISTA REHAB AT COMMUNITY DEVELOPMENT, INC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
May 13, 2021
Last certification
May 13, 2021
Ownership / control type
Proprietary
Facility address
411 Oak Street
Richton, MS 39476

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2228925Community Development Inc411 Oak St, Richton, MS 39476Certificate of waiverJul 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Trivista8 organizations share this tax ID, including this one
Part of
Trivista

Other organizations with this tax ID 7

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

Locations

60139 Cotton Gin Port Rd
Amory, MS 38821
Phone (662) 256-8406

1681 Virginia Ln
Corinth, MS 38834
Phone (662) 287-5662

36 Elm Ln
Ecru, MS 38841
Phone (662) 489-6462

616 E 19th St
Laurel, MS 39440

200 Knight Dr
Rm 230
Saltillo, MS 38866

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1265025522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3592",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033592",
            "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": "411 OAK ST.",
            "city": "RICHTON",
            "state": "MS",
            "postal_code": "39476",
            "telephone_number": "662-270-6486",
            "fax_number": "662-842-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-VISTA REHAB, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-VISTA REHAB, INC",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "BOUTIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-840-0535",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TriVista Rehab at Community Development Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richton, MS

Sources for this page

Verify at the official NPI Registry.