Provider Demographics
NPI:1013239722
Name:XTREME CARE REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:XTREME CARE REHABILITATION CENTER INC
Other - Org Name:XTREME CARE REHABILITATION CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:CH5345
Authorized Official - Phone:239-424-8442
Mailing Address - Street 1:2002 DEL PRADO BLVD S STE 100
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-4557
Mailing Address - Country:US
Mailing Address - Phone:239-424-8442
Mailing Address - Fax:239-424-8443
Practice Address - Street 1:2002 DEL PRADO BLVD S STE 100
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4557
Practice Address - Country:US
Practice Address - Phone:239-424-8442
Practice Address - Fax:239-424-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty