Basic Information
| Provider Information | |||||||||
| NPI: | 1629178645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | H2 REHABILITATION SERVICES OF FLORIDA LLC | ||||||||
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| OtherOrganizationName: | H2 HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 484 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322024912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045053081 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8087 NORMANDY BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322216646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047815666 | ||||||||
| FaxNumber: | 9047818191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | STREETER | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9049444063 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 160630507 | 01 | FL | DEPARTMENT OF LABOR | OTHER | 4477946 | 01 | FL | AETNA NON-HMO | OTHER | 4919861 | 01 | FL | CIGNA | OTHER | 8845212-15 | 05 | FL | MEDICAID | QC9 | 01 | FL | BCBS | OTHER | 102701 | 01 | FL | AVMED | OTHER | 028499800 | 05 | FL | MEDICAID |