Healthcare Provider Details

I. General information

NPI: 1790471845
Provider Name (Legal Business Name): EVEREST REHABILITATION HOSPITAL ST. PETE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 GATEWAY CENTRE PARKWAY
PINELLAS PARK FL
33782
US

IV. Provider business mailing address

5100 BELT LINE ROAD STE 310
DALLAS TX
75254-7124
US

V. Phone/Fax

Practice location:
  • Phone: 469-223-5749
  • Fax:
Mailing address:
  • Phone: 469-223-5749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. OMAR JENKINS
Title or Position: CFO
Credential:
Phone: 469-223-5749