Healthcare Provider Details

I. General information

NPI: 1790854669
Provider Name (Legal Business Name): COMMUNITYREHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 BEECHWOOD ST
JACKSONVILLE FL
32206-6236
US

IV. Provider business mailing address

623 BEECHWOOD ST
JACKSONVILLE FL
32206-6236
US

V. Phone/Fax

Practice location:
  • Phone: 904-358-1211
  • Fax: 904-349-8555
Mailing address:
  • Phone: 904-358-1211
  • Fax: 904-349-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. REGINALD L GAFFNEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-358-1211