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General NPI Number Information
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NPI Number | 1396950341
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Entity Type | Organization
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Legal Business Name | PROVIDENTIAL HEALTH & REHAB, INC.
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5205 S ORANGE AVE STE 102
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City | ORLANDO
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State | FL
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Zip | 32809-3067
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Country | US
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Telephone | 407-856-8584
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Fax |
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Provider Business Mailing Address
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Address Line | 5205 S ORANGE AVE STE 102
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City | ORLANDO
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State | FL
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Zip | 32809-3067
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Country | US
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Telephone | 407-856-8584
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MAXIMIN VICTOR
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Credential |
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Telephone | 407-856-8584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | HCC6145
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License Number State | FL
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