Provider Demographics
NPI:1750530747
Name:12 KEYS REHAB INC
Entity type:Organization
Organization Name:12 KEYS REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-678-0078
Mailing Address - Street 1:3203 NE MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7261
Mailing Address - Country:US
Mailing Address - Phone:954-678-0078
Mailing Address - Fax:772-323-2679
Practice Address - Street 1:618 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4750
Practice Address - Country:US
Practice Address - Phone:772-323-2676
Practice Address - Fax:772-323-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1943AD158702261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder