Provider Demographics
NPI:1215188263
Name:REHABILITATION CENTER OF ST PETERSBURG INC
Entity Type:Organization
Organization Name:REHABILITATION CENTER OF ST PETERSBURG INC
Other - Org Name:REHABILITATION CENTER OF ST PETE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-822-1871
Mailing Address - Street 1:435 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4504
Mailing Address - Country:US
Mailing Address - Phone:727-822-1871
Mailing Address - Fax:727-894-0836
Practice Address - Street 1:435 42ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-4504
Practice Address - Country:US
Practice Address - Phone:727-822-1871
Practice Address - Fax:727-894-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10 5772OtherPART A MEDICARE PROVIDER#