Provider Demographics
NPI:1457660771
Name:IMPERIAL REHAB LLC
Entity Type:Organization
Organization Name:IMPERIAL REHAB LLC
Other - Org Name:IMPERIAL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-591-4800
Mailing Address - Street 1:900 IMPERIAL GOLF COURSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1085
Mailing Address - Country:US
Mailing Address - Phone:386-257-6362
Mailing Address - Fax:386-257-2197
Practice Address - Street 1:900 IMPERIAL GOLF COURSE BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1085
Practice Address - Country:US
Practice Address - Phone:386-257-6362
Practice Address - Fax:386-257-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
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
FL105738Medicare Oscar/Certification