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General NPI Number Information
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NPI Number | 1225579311
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Entity Type | Organization
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Legal Business Name | JEFFERSON REHABILITATION CENTER
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 615 WEST MAIN STREET
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City | WATERTOWN
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State | NY
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Zip | 13601
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Country | US
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Telephone | 315-836-1408
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Fax |
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Provider Business Mailing Address
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Address Line | 615 W MAIN ST
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City | WATERTOWN
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State | NY
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Zip | 13601-1337
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Country | US
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Telephone | 315-836-1408
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Fax |
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Authorized Official
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Title or Position | CONTROLLER/DIRECTOR OF FINANCE AND
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Name | MRS. JILL A ALLEN
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Credential |
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Telephone | 315-836-1251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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