Provider Demographics
NPI:1598794141
Name:CORA HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CORA HEALTH SERVICES INC
Other - Org Name:CORA REHABILITATION CLINICS - POINCIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRZYMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-221-6717
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0150
Mailing Address - Country:US
Mailing Address - Phone:419-221-6717
Mailing Address - Fax:419-222-0507
Practice Address - Street 1:3350 WEST SOUTHPORT ROAD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2706
Practice Address - Country:US
Practice Address - Phone:407-846-0152
Practice Address - Fax:407-846-1225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-03
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQODOtherBLUE CROSS BLUE SHIELD
FL=========119OtherTRICARE
106690Medicare Oscar/Certification