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General NPI Number Information
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NPI Number | 1790471845
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Entity Type | Organization
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Legal Business Name | EVEREST REHABILITATION HOSPITAL ST. PETE LLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 3410 GATEWAY CENTRE PARKWAY
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City | PINELLAS PARK
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State | FL
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Zip | 33782
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Country | US
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Telephone | 469-223-5749
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 BELT LINE ROAD STE 310
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City | DALLAS
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State | TX
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Zip | 75254-7124
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Country | US
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Telephone | 469-223-5749
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. OMAR JENKINS
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Credential |
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Telephone | 469-223-5749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number |
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License Number State |
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