Healthcare Provider Details

I. General information

NPI: 1952733586
Provider Name (Legal Business Name): CORA REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 S STATE ROAD 15A
DELAND FL
32720-7817
US

IV. Provider business mailing address

1110 SHAWNEE RD
LIMA OH
45805-3529
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-9400
  • Fax:
Mailing address:
  • Phone: 419-221-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number320700000X
License Number StateFL

VIII. Authorized Official

Name: ANDREA K BEACH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 419-221-6710