1649438805 NPI number — SUNCREST OUTPATIENT REHAB SERVICES, LLC

Table of content: (NPI 1649438805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649438805 NPI number — SUNCREST OUTPATIENT REHAB SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNCREST OUTPATIENT REHAB SERVICES, 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:
6
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:
1649438805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37115-5033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-627-9267
Provider Business Mailing Address Fax Number:
615-577-0081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32204-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-353-2019
Provider Business Practice Location Address Fax Number:
904-353-7762
Provider Enumeration Date:
05/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCFADDIN
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF LICENSING/ACCREDITATION
Authorized Official Telephone Number:
615-712-2250

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)

  • Identifier: AS074 . This is a "PROVIDER NO." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HCC9132 . This is a "STATE LICENSE NO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com