Provider Demographics
NPI:1477633204
Name:NATURE COAST REHABILITATION INC
Entity Type:Organization
Organization Name:NATURE COAST REHABILITATION INC
Other - Org Name:NATURE COAST REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-529-0012
Mailing Address - Street 1:25050 W NEWBERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-5050
Mailing Address - Country:US
Mailing Address - Phone:352-472-1400
Mailing Address - Fax:352-472-1300
Practice Address - Street 1:37 SOUTH MAIN STREET, SUITE C
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2548
Practice Address - Country:US
Practice Address - Phone:352-529-0012
Practice Address - Fax:352-528-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL298499OtherAVMED
FL890647500Medicaid
FL890647500Medicaid