Provider Demographics
NPI:1215228226
Name:ORTHOPEDIC RESHABILITATION UNIT
Entity Type:Organization
Organization Name:ORTHOPEDIC RESHABILITATION UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIYAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-308-1290
Mailing Address - Street 1:1750 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4664
Mailing Address - Country:US
Mailing Address - Phone:904-308-4700
Mailing Address - Fax:
Practice Address - Street 1:1750 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4664
Practice Address - Country:US
Practice Address - Phone:904-308-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CATHERINE LABOURE MANOR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1517096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020515000Medicaid
FL080473001OtherDME MAC
FL020515000Medicaid
FL080473001OtherDME MAC