1245467471 NPI number — SUNCREST OUTPATIENT REHAB SERVICES OF TN, LLC

Table of content: (NPI 1245467471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245467471 NPI number — SUNCREST OUTPATIENT REHAB SERVICES OF TN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCREST OUTPATIENT REHAB SERVICES OF TN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUNCREST REHAB SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245467471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11555 HERON BAY BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33076-3360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-707-5880
Provider Business Mailing Address Fax Number:
954-753-4932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4131 ANDREW JACKSON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37076-2270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-612-7602
Provider Business Practice Location Address Fax Number:
615-612-7695
Provider Enumeration Date:
06/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF REGULATORY AFFAIRS
Authorized Official Telephone Number:
954-707-5880

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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