Provider Demographics
NPI:1225579311
Name:JEFFERSON REHABILITATION CENTER
Entity type:Organization
Organization Name:JEFFERSON REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER/DIRECTOR OF FINANCE AND
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-836-1251
Mailing Address - Street 1:615 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1337
Mailing Address - Country:US
Mailing Address - Phone:315-836-1408
Mailing Address - Fax:
Practice Address - Street 1:615 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-836-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service