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NPI Code Detail

MEDICARE: COMMUNTIY REHABILITATION CENTER, INC.

MEDICARE: COMMUNTIY REHABILITATION 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
1251B00000XCase Management AgencyFL

General Provider Information

NPI Number : 1952304511
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNTIY REHABILITATION CENTER, INC.
Provider Business Mailing Address
First Line : 623 BEECHWOOD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-6236
Country : US
Telephone Number : 904-358-1211
Fax Number : 904-358-1551
Provider Business Practice Location Address
First Line : 623 BEECHWOOD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-6236
Country : US
Telephone Number : 904-358-1211
Fax Number : 904-358-1551
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. REGINALD L GAFFNEY SR.
Credential : EXECUTIVE DIRECTOR
Telephone Number : 904-358-1211
Provider Enumeration Date : 05/27/2005
Last Update Date : 08/22/2020

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