Provider Demographics
NPI:1699866988
Name:REHAB 1OF CHARLOTTE COUNTY, INC.
Entity type:Organization
Organization Name:REHAB 1OF CHARLOTTE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-766-1110
Mailing Address - Street 1:4166 TAMIAMI TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9209
Mailing Address - Country:US
Mailing Address - Phone:941-766-1110
Mailing Address - Fax:941-766-1190
Practice Address - Street 1:4166 TAMIAMI TRL
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9209
Practice Address - Country:US
Practice Address - Phone:941-766-1110
Practice Address - Fax:941-766-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686605Medicare ID - Type UnspecifiedOUTPATIENT REHAB FACILITY