MEDICARE: COOPERATIVE REHAB 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	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1669416426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPERATIVE REHAB SERVICES, LLC

Provider Business Mailing Address
First Line	:	3599 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4252
Country	:	US
Telephone Number	:	904-858-7606
Fax Number	:	904-858-7476

Provider Business Practice Location Address
First Line	:	1111 GLYNCO PKWY
Second Line	:	SUITE 110
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-7921
Country	:	US
Telephone Number	:	912-264-5377
Fax Number	:	912-262-1889

Authorized Official
Title or Position	:	VP/CHIEF FINANCIAL OFFICER
Name	:	TIMOTHY REINSCHMIDT
Credential	:
Telephone Number	:	904-858-7488

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	09/21/2007

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