South Rehabilitation Center, Inc.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

SOUTH REHABILITATION CENTER, INC.

Practice address

3975 S Orange Blossom TRL Ste 105
Orlando, FL 32839-7905

Phone

(407) 601-4929

Fax

(407) 730-3237

NPI assigned

Jan 18, 2012

Last updated

Mar 19, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dedrix Daka

Title

Ceo

Phone

(904) 423-0017

Specialties & licenses 4

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carmaneila L. Green

  • Clinical Social Worker
  • St Augustine, FL
  • NPI 1396001756

  Mental Health

  NPD (past)
• Vernon Ricardo Washington, M.A.

  • Mental Health Counselor
  • St Augustine, FL
  • NPI 1184969008
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1396016606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 ELLIS RD S STE 118",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322543567",
            "telephone_number": "904-423-0017",
            "fax_number": "904-683-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3975 S ORANGE BLOSSOM TRL STE 105",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328397905",
            "telephone_number": "407-601-4929",
            "fax_number": "407-730-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH REHABILITATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "DAKA",
        "authorized_official_first_name": "DEDRIX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-423-0017"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011926000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004720700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Stacy Southall, RN
• Southchase Community Pharmacy (Patients First Pharmacy)
• Southeast Medical Imaging, Services
• Southeastern Clinical Services,Inc.
• Southeastern Dental Group (Family And Cosmetic Dentistry At Vista Lakes)

• Psychiatry Physician in Orlando, FL
• Providers in Orlando, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.