Provider Demographics
NPI:1407922735
Name:THE VILLAGES REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:THE VILLAGES REHABILITATION SERVICES LLC
Other - Org Name:LAKE CENTRE FOR REHABILITATION AT THE VILLAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-728-6636
Mailing Address - Street 1:PO BOX 491313
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1313
Mailing Address - Country:US
Mailing Address - Phone:352-728-6636
Mailing Address - Fax:352-787-4522
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:BUILDING 800, SUITE 830
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-753-6999
Practice Address - Fax:352-259-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG9VOtherBCBS
FLG9VOtherBCBS