MEDICARE: EVEREST REHABILITATION SERVICES 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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	MD437798	PA

General Provider Information

NPI Number	:	1386094027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVEREST REHABILITATION SERVICES LLC

Provider Business Mailing Address
First Line	:	23 MOUNT AIRE FARM RD
Second Line	:
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-3356
Country	:	US
Telephone Number	:	610-812-5752
Fax Number	:

Provider Business Practice Location Address
First Line	:	6787 MARKET ST STE 102
Second Line	:
City	:	MILLBOURNE
State	:	PA
Zip	:	19082-1848
Country	:	US
Telephone Number	:	610-812-5752
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. GUOFANG WANG
Credential	:	MD
Telephone Number	:	610-812-5752

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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