| Organization Name: | ST JOHNS REHABILITATION HOSPITAL AND NURSING CENTER INC |
| NPI Number: | 1124016688 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAM GAMBARDELLA (ADMINISTRATOR/EXECUTIVE DIRECTOR) |
| Mailing Address: | 3487 Nw 30th St Lauderdale Lakes |
| State: | FL US |
| Postal Code: | 333111103 |
| Phone Number: | 9547396233 |
| Fax Number: | 9544854023 |
| NPI Enumeration Date: | 10/10/2005 |
| NPI Last Update Date: | 02/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | FL4478 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |