Provider Demographics
NPI:1790471845
Name:EVEREST REHABILITATION HOSPITAL ST. PETE LLC
Entity Type:Organization
Organization Name:EVEREST REHABILITATION HOSPITAL ST. PETE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-223-5749
Mailing Address - Street 1:5100 BELT LINE ROAD
Mailing Address - Street 2:STE 310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7124
Mailing Address - Country:US
Mailing Address - Phone:469-223-5749
Mailing Address - Fax:
Practice Address - Street 1:3410 GATEWAY CENTRE PARKWAY
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:469-223-5749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital