Healthcare Provider Details

I. General information

NPI: 1245571769
Provider Name (Legal Business Name): ENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 FOAL RD
LAKE WORTH FL
33449-5446
US

IV. Provider business mailing address

10155 FOAL RD
LAKE WORTH FL
33449-5446
US

V. Phone/Fax

Practice location:
  • Phone: 201-323-9834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT12746
License Number StateFL

VIII. Authorized Official

Name: MARY WRINN
Title or Position: PT
Credential: PT
Phone: 18008044404