Provider Demographics
NPI:1831900760
Name:JUPITER FL REHAB LLC
Entity type:Organization
Organization Name:JUPITER FL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:YECHEZKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOYELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:326-194-8977
Mailing Address - Street 1:4 BRIGHTON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1668
Mailing Address - Country:US
Mailing Address - Phone:917-613-4386
Mailing Address - Fax:
Practice Address - Street 1:17781 THELMA AVE
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7942
Practice Address - Country:US
Practice Address - Phone:732-619-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility