1720316383 NPI number — CONFICARE REHABILITATION SOLUTIONS LLC

Table of content: (NPI 1720316383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720316383 NPI number — CONFICARE REHABILITATION SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONFICARE REHABILITATION SOLUTIONS 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:
Provider Other Organization Name Type Code:
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:
1720316383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 ORMSBY STATION CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-315-1724
Provider Business Mailing Address Fax Number:
502-515-1184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E HOWRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32724-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-624-6926
Provider Business Practice Location Address Fax Number:
386-873-2905
Provider Enumeration Date:
11/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BUSH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
502-315-1724

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com