Provider Demographics
NPI:1821312646
Name:GARDEN CITY REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:GARDEN CITY REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:401-946-2400
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6068
Mailing Address - Country:US
Mailing Address - Phone:401-946-2400
Mailing Address - Fax:401-946-5862
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-946-2400
Practice Address - Fax:401-946-5862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARDEN CITY TREATMENT CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-23
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy