Provider Demographics
NPI:1164507422
Name:OCCUPATIONAL AND REHABILITATION CENTER PA
Entity Type:Organization
Organization Name:OCCUPATIONAL AND REHABILITATION CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CHIEF LEGAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:904-260-3011
Mailing Address - Street 1:6144 GAZEBO PARK PL S STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1086
Mailing Address - Country:US
Mailing Address - Phone:904-260-3011
Mailing Address - Fax:904-260-3170
Practice Address - Street 1:6144 GAZEBO PARK PL S STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1086
Practice Address - Country:US
Practice Address - Phone:904-260-3011
Practice Address - Fax:904-260-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty