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NPI Code Detail

MEDICARE: ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC

MEDICARE: ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC
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
1261QM1300XMulti-Specialty Clinic/CenterFL4478FL
2283X00000XRehabilitation HospitalFL4478FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124016688
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC
Provider Business Mailing Address
First Line : 3487 NW 30TH ST
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33311-1103
Country : US
Telephone Number : 954-739-6233
Fax Number : 954-485-4023
Provider Business Practice Location Address
First Line : 3487 NW 30TH ST
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33311-1103
Country : US
Telephone Number : 954-739-6233
Fax Number : 954-485-4023
Authorized Official
Title or Position : REGIONAL DIR. HOSPITAL OPERATIONS
Name : JAIME GONZALEZ
Credential :
Telephone Number : 954-739-6233
Provider Enumeration Date : 10/10/2005
Last Update Date : 01/30/2020

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