Provider Demographics
NPI:1467510818
Name:SPEECH & NEUROREHAB CENTER INC
Entity Type:Organization
Organization Name:SPEECH & NEUROREHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-484-9292
Mailing Address - Street 1:1108 A AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-484-9292
Mailing Address - Fax:850-484-9525
Practice Address - Street 1:1108 A AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-484-9292
Practice Address - Fax:850-484-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880361700Medicaid
FL106669Medicare PIN