Provider Demographics
NPI:1326289521
Name:FOCUS NEUROREHAB, LLC
Entity Type:Organization
Organization Name:FOCUS NEUROREHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:407-362-1902
Mailing Address - Street 1:255 PRIMERA BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2168
Mailing Address - Country:US
Mailing Address - Phone:407-362-1902
Mailing Address - Fax:407-804-9769
Practice Address - Street 1:255 PRIMERA BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2168
Practice Address - Country:US
Practice Address - Phone:407-362-1902
Practice Address - Fax:407-804-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564320000261QR0400X, 261QM0850X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202949801Medicaid