Healthcare Provider Details

I. General information

NPI: 1386835650
Provider Name (Legal Business Name): GAINESVILLE HEALTH AD REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SW 20TH AVENUE
GAINESVILLE FL
32607
US

IV. Provider business mailing address

4000 SW 20TH AVENUE
GAINESVILLE FL
32607
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-1981
  • Fax: 352-377-1981
Mailing address:
  • Phone: 352-377-1981
  • Fax: 352-377-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1170096
License Number StateFL

VIII. Authorized Official

Name: MR. AARON LAMAR DALLAS
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 352-377-1981