Provider Demographics
NPI: | 1184647182 |
---|---|
Name: | GUIDING LIGHT REHAB, INC |
Entity Type: | Organization |
Organization Name: | GUIDING LIGHT REHAB, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARIO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ANZALONE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 352-592-7647 |
Mailing Address - Street 1: | 4422 COMMERCIAL WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRING HILL |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34606-1966 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-592-7647 |
Mailing Address - Fax: | 352-596-3418 |
Practice Address - Street 1: | 4422 COMMERCIAL WAY |
Practice Address - Street 2: | |
Practice Address - City: | SPRING HILL |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34606-1966 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-592-7647 |
Practice Address - Fax: | 352-596-3418 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-25 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 2005-00552845 | 261QR0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |