MEDICARE: CLERMONT AND AREA REHABILITATION SOLUTIONS 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
1	261QM1300X	Multi-Specialty Clinic/Center	8760009368	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5672933	OTHER	FL	CCN/FIRST HEALTH

General Provider Information

NPI Number	:	1922049303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLERMONT AND AREA REHABILITATION SOLUTIONS INC

Provider Business Mailing Address
First Line	:	PO BOX 648
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34755-0648
Country	:	US
Telephone Number	:	352-404-4523
Fax Number	:	352-536-6996

Provider Business Practice Location Address
First Line	:	1705 E HWY 50 STE A
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5186
Country	:	US
Telephone Number	:	352-404-4523
Fax Number	:	352-536-6996

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JACQUELINE T WEEKES
Credential	:	OTRL
Telephone Number	:	352-404-4523

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/19/2007

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