Provider Demographics
NPI:1871244970
Name:REHAB AT HOME LLC
Entity Type:Organization
Organization Name:REHAB AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-414-5901
Mailing Address - Street 1:1694 BAYHILL DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1956
Mailing Address - Country:US
Mailing Address - Phone:727-459-6615
Mailing Address - Fax:352-493-9682
Practice Address - Street 1:1310 W NORTH BLVD # 3
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3922
Practice Address - Country:US
Practice Address - Phone:352-414-5901
Practice Address - Fax:352-493-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health