Provider Demographics
NPI:1245467471
Name:SUNCREST OUTPATIENT REHAB SERVICES OF TN, LLC
Entity type:Organization
Organization Name:SUNCREST OUTPATIENT REHAB SERVICES OF TN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REGULATORY AFFAIRS
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-707-5880
Mailing Address - Street 1:11555 HERON BAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3360
Mailing Address - Country:US
Mailing Address - Phone:954-707-5880
Mailing Address - Fax:954-753-4932
Practice Address - Street 1:4131 ANDREW JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2270
Practice Address - Country:US
Practice Address - Phone:615-612-7602
Practice Address - Fax:615-612-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370336Medicare Oscar/Certification