Healthcare Provider Details

I. General information

NPI: 1245680701
Provider Name (Legal Business Name): J. ROUGEAU REHAB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SAVOY RD
FLORIDA MA
01247-9658
US

IV. Provider business mailing address

27 SAVOY RD
FLORIDA MA
01247-9658
US

V. Phone/Fax

Practice location:
  • Phone: 413-441-5371
  • Fax:
Mailing address:
  • Phone: 413-441-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number8529
License Number StateMA

VIII. Authorized Official

Name: MRS. JACQUELINE MIGNON ROUGEAU
Title or Position: PRESIDENT
Credential: PT
Phone: 413-441-5371