Provider Demographics
NPI:1669571733
Name:H2 REHABILITATION SERVICES OF FLORIDA LLC
Entity type:Organization
Organization Name:H2 REHABILITATION SERVICES OF FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-699-9395
Mailing Address - Street 1:PO BOX 932184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4530 SAINT JOHNS AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1852
Practice Address - Country:US
Practice Address - Phone:904-384-4415
Practice Address - Fax:904-384-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8845212-17Medicaid
FL106870Medicare Oscar/Certification
FL160630505OtherDEPARTMENT OF LABOR
FL4827470002Medicare NSC
FL8014171OtherCIGNA
FL8845212-17Medicaid
FL106870Medicare Oscar/Certification
FL=========007OtherTRICARE
FL4532295OtherAETNA NON-HMO
FL028586200Medicaid