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General NPI Number Information
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NPI Number | 1780958314
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Entity Type | Organization
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Legal Business Name | INDIAN REHABILITATION CENTER, INC
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 3636 UNIVERSITY BLVD S STE A7
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4250
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Country | US
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Telephone | 904-232-8468
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Fax | 904-232-8469
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Provider Business Mailing Address
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Address Line | PO BOX 16717
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City | JACKSONVILLE
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State | FL
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Zip | 32245-6717
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Country | US
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Telephone | 904-232-8468
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Fax | 904-232-8469
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Authorized Official
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Title or Position | MANAGER
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Name | REINER FERRER
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Credential |
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Telephone | 904-232-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | MM 28433
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License Number State | FL
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