Healthcare Provider Details

I. General information

NPI: 1932501319
Provider Name (Legal Business Name): ENCORE PREAKNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 MATHISTOWN RD ROOM 152
LITTLE EGG HARBOR TWP NJ
08087-4066
US

IV. Provider business mailing address

4025 TAMPA RD STE 1106 LEGAL DEPT
OLDSMAR FL
34677-3213
US

V. Phone/Fax

Practice location:
  • Phone: 609-857-4141
  • Fax:
Mailing address:
  • Phone: 888-974-7878
  • Fax: 727-726-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SUE E OLSEN
Title or Position: VICE PRESIDENT
Credential: CCC-SLP
Phone: 727-510-3850