Provider Demographics
NPI:1649438805
Name:SUNCREST OUTPATIENT REHAB SERVICES, LLC
Entity type:Organization
Organization Name:SUNCREST OUTPATIENT REHAB SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LICENSING/ACCREDITATION
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-712-2250
Mailing Address - Street 1:510 HOSPITAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5033
Mailing Address - Country:US
Mailing Address - Phone:615-627-9267
Mailing Address - Fax:615-577-0081
Practice Address - Street 1:1503 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3910
Practice Address - Country:US
Practice Address - Phone:904-353-2019
Practice Address - Fax:904-353-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2012-06-29
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
FLAS074OtherPROVIDER NO.
FLHCC9132OtherSTATE LICENSE NO