1790471845 NPI number — EVEREST REHABILITATION HOSPITAL ST. PETE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790471845 NPI number — EVEREST REHABILITATION HOSPITAL ST. PETE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVEREST REHABILITATION HOSPITAL ST. PETE 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:
1790471845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 BELT LINE ROAD
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254-7124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-223-5749
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3410 GATEWAY CENTRE PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINELLAS PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-223-5749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
OMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
469-223-5749

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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