Provider Demographics
NPI:1225189525
Name:CENTRAL FLORIDA CLINIC FOR REHABILITATION
Entity Type:Organization
Organization Name:CENTRAL FLORIDA CLINIC FOR REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:GERRITS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:SCD,CCC-SP
Authorized Official - Phone:352-795-4114
Mailing Address - Street 1:255 SE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4891
Mailing Address - Country:US
Mailing Address - Phone:352-795-4114
Mailing Address - Fax:352-563-2438
Practice Address - Street 1:255 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4891
Practice Address - Country:US
Practice Address - Phone:352-795-4114
Practice Address - Fax:352-563-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCCR2624261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1737737OtherFIRST HEALTH
FLC178OtherPEDIACARE
FL671853196OtherMED WAIVER-ADEPT
FL880658600Medicaid
FL168089OtherHEALTHEASE
FL101374-0379OtherA VMED
FL920841-2051OtherNETWORK SYNERGY
FLR90OtherBLUE CROSS BLUE SHIELD
FLC178OtherPEDIACARE
FL106609Medicare ID - Type Unspecified