MEDICARE: REHAB NEXUS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1093179277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB NEXUS, LLC

Provider Business Mailing Address
First Line	:	6574 N STATE ROAD 7
Second Line	:	#284
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-3625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 WILES RD
Second Line	:	SUITE 105
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4106
Country	:	US
Telephone Number	:	561-715-3260
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JORDAN NEEDELL
Credential	:
Telephone Number	:	561-715-3260

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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