Healthcare Provider Details

I. General information

NPI: 1952610016
Provider Name (Legal Business Name): WINDERMERE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 CASON COVE DR
ORLANDO FL
32811-6302
US

IV. Provider business mailing address

4875 CASON COVE DR
ORLANDO FL
32811-6302
US

V. Phone/Fax

Practice location:
  • Phone: 407-420-2090
  • Fax: 407-420-5998
Mailing address:
  • Phone: 407-420-2090
  • Fax: 407-420-5998

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: 407-420-2090