Basic Information
| Provider Information | |||||||||
| NPI: | 1124016688 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. ANTHONY'S REHABILITATION HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3487 NW 30TH ST | ||||||||
| Address2: | |||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333111103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547396233 | ||||||||
| FaxNumber: | 9544854023 | ||||||||
| Practice Location | |||||||||
| Address1: | 3487 NW 30TH ST | ||||||||
| Address2: | |||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333111103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547396233 | ||||||||
| FaxNumber: | 9544854023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | JAIME | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL DIR. HOSPITAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9547396233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | FL4478 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 283X00000X | FL4478 | FL | Y | Hospitals | Rehabilitation Hospital |
No ID Information.