Healthcare Provider Details

I. General information

NPI: 1366682965
Provider Name (Legal Business Name): HIAWASSEE HEALTH & REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W COLONIAL DR
ORLANDO FL
32818-7800
US

IV. Provider business mailing address

6500 W COLONIAL DR
ORLANDO FL
32818-7800
US

V. Phone/Fax

Practice location:
  • Phone: 407-403-5400
  • Fax: 407-403-5401
Mailing address:
  • Phone: 407-403-5400
  • Fax: 407-403-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. RODRIGUE BOSSOUS
Title or Position: MANAGER
Credential:
Phone: 407-403-5400