Provider Demographics
NPI:1538249198
Name:WAUCHULA INTEGRATED NETWORKED NEUROLOGIC REHABILITATION, INC.
Entity type:Organization
Organization Name:WAUCHULA INTEGRATED NETWORKED NEUROLOGIC REHABILITATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-767-4483
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-1348
Mailing Address - Country:US
Mailing Address - Phone:863-773-2857
Mailing Address - Fax:863-773-2041
Practice Address - Street 1:1531 JOHNS RD
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-8492
Practice Address - Country:US
Practice Address - Phone:863-767-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9816310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility