MEDICARE: REDMOND PARK HOSPITAL, 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	273Y00000X	Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1548214257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDMOND PARK HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	501 REDMOND RD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1415
Country	:	US
Telephone Number	:	706-368-8386
Fax Number	:	706-291-0971

Provider Business Practice Location Address
First Line	:	501 REDMOND RD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1415
Country	:	US
Telephone Number	:	706-368-8386
Fax Number	:	706-291-0971

Authorized Official
Title or Position	:	CFO
Name	:	JEFFREY PRUSIA
Credential	:
Telephone Number	:	706-802-3029

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	01/18/2024

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Directions to “REDMOND PARK HOSPITAL, LLC ” Practice Location

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