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NPI Code Detail

MEDICARE: SOUTH REHABILITATION CENTER, INC.

MEDICARE: SOUTH REHABILITATION CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency1602FL

General Provider Information

NPI Number : 1003273244
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH REHABILITATION CENTER, INC.
Provider Business Mailing Address
First Line : 580 ELLIS RD S
Second Line : SUITE 118
City : JACKSONVILLE
State : FL
Zip : 32254-3582
Country : US
Telephone Number : 904-423-0017
Fax Number : 904-683-8169
Provider Business Practice Location Address
First Line : 580 ELLIS RD S
Second Line : SUITE 118
City : JACKSONVILLE
State : FL
Zip : 32254-3582
Country : US
Telephone Number : 904-423-0017
Fax Number : 904-683-8169
Authorized Official
Title or Position : CEO
Name : MR. DEDRIX DAKA
Credential :
Telephone Number : 904-423-0017
Provider Enumeration Date : 01/19/2016
Last Update Date : 07/21/2022

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