Provider Demographics
NPI:1124016688
Name:ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC
Entity Type:Organization
Organization Name:ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC
Other - Org Name:ST. ANTHONY'S REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIR. HOSPITAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-739-6233
Mailing Address - Street 1:3487 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1103
Mailing Address - Country:US
Mailing Address - Phone:954-739-6233
Mailing Address - Fax:954-485-4023
Practice Address - Street 1:3487 NW 30TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-1103
Practice Address - Country:US
Practice Address - Phone:954-739-6233
Practice Address - Fax:954-485-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL4478261QM1300X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010240700Medicare ID - Type Unspecified
FL103027Medicare ID - Type Unspecified