Provider Demographics
NPI:1952304511
Name:COMMUNTIY REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:COMMUNTIY REHABILITATION CENTER, INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:904-358-1211
Mailing Address - Street 1:623 BEECHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-6236
Mailing Address - Country:US
Mailing Address - Phone:904-358-1211
Mailing Address - Fax:904-358-1551
Practice Address - Street 1:623 BEECHWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-6236
Practice Address - Country:US
Practice Address - Phone:904-358-1211
Practice Address - Fax:904-358-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management