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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
1313M00000XNursing Facility/Intermediate Care FacilityFL
2314000000XSkilled Nursing FacilitySNF1520096FL

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 : 1578559902
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC
Provider Business Mailing Address
First Line : 3075 NW 35TH AVE
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33311-1107
Country : US
Telephone Number : 954-739-6233
Fax Number : 954-733-9579
Provider Business Practice Location Address
First Line : 3075 NW 35TH AVE
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33311-1107
Country : US
Telephone Number : 954-739-6233
Fax Number : 954-733-9579
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : ROSEMARIE BAILEY
Credential : NHA
Telephone Number : 954-739-6233
Provider Enumeration Date : 09/21/2005
Last Update Date : 07/21/2022

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