Healthcare Provider Details

I. General information

NPI: 1457660771
Provider Name (Legal Business Name): IMPERIAL REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 IMPERIAL GOLF COURSE BLVD
NAPLES FL
34110-1085
US

IV. Provider business mailing address

900 IMPERIAL GOLF COURSE BLVD
NAPLES FL
34110-1085
US

V. Phone/Fax

Practice location:
  • Phone: 386-257-6362
  • Fax: 386-257-2197
Mailing address:
  • Phone: 386-257-6362
  • Fax: 386-257-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN E WARREN
Title or Position: MGR
Credential:
Phone: 239-591-4800