Organization
SOUTH REHABILITATION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEDRIX DAKA (CEO)
(904) 423-0017
Entity
Organization
Contact information
Practice address
3975 S ORANGE BLOSSOM TRL STE 105, ORLANDO, FL 32839-7905
(407) 601-4929
(407) 730-3237
Mailing address
580 ELLIS RD S STE 118, JACKSONVILLE, FL 32254-3567
(904) 423-0017
(904) 683-8169
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004720700
—
FL
05
—
011926000
—
FL
Enumeration date
01/18/2012
Last updated
03/19/2015
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