Basic Information
| Provider Information | |||||||||
| NPI: | 1467993188 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | H2 REHABILITATION EXTENSION SERVICES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | H2 HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 554 KINGSLEY AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320734830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045053081 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 HOCH RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BLANDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 195109644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846378383 | ||||||||
| FaxNumber: | 6109291606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2017 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | STREETER | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9045053081 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.