Provider Demographics
NPI:1619276482
Name:HIBISCUS HOUSE REHAB, LLC
Entity Type:Organization
Organization Name:HIBISCUS HOUSE REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AOWYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-224-5004
Mailing Address - Street 1:1338 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4108
Mailing Address - Country:US
Mailing Address - Phone:352-224-5004
Mailing Address - Fax:352-224-5234
Practice Address - Street 1:1338 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4108
Practice Address - Country:US
Practice Address - Phone:352-224-5004
Practice Address - Fax:352-224-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-19
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2757261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEZ924AMedicare PIN