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General NPI Number Information
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NPI Number | 1932685880
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Entity Type | Organization
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Legal Business Name | LANIER REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 12740 LANIER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32226-1704
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Country | US
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Telephone | 904-757-2548
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Fax | 904-475-7047
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Provider Business Mailing Address
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Address Line | 101 SUNNYTOWN RD STE 201
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City | CASSELBERRY
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State | FL
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Zip | 32707-3862
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Country | US
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Telephone | 470-830-5309
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Fax | 470-830-7775
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Authorized Official
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Title or Position | CFO
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Name | MR. DON MELTON
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Credential |
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Telephone | 407-830-5309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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