=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760892657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOSEVELT WARM SPRINGS REHABILITATION & SPECIALTY HOSPITALS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2014
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6135 ROOSEVELT HWY
-----------------------------------------------------
City | WARM SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31830-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-655-5461
-----------------------------------------------------
Fax | 706-655-5011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6135 ROOSEVELT HWY PO BOX 280
-----------------------------------------------------
City | WARM SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31830-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-655-5461
-----------------------------------------------------
Fax | 706-655-5011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR & COO
-----------------------------------------------------
Name | MR. DAVID MORK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-655-5515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number | 099684
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------