Provider Demographics
NPI:1033619846
Name:ST MARK VILLAGE INC
Entity Type:Organization
Organization Name:ST MARK VILLAGE INC
Other - Org Name:VILLAGE HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POHL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:727-785-2577
Mailing Address - Street 1:2655 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2630
Mailing Address - Country:US
Mailing Address - Phone:727-785-2577
Mailing Address - Fax:727-464-1785
Practice Address - Street 1:2655 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2630
Practice Address - Country:US
Practice Address - Phone:727-785-2577
Practice Address - Fax:727-464-1785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARK VILLAGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy