Provider Demographics
NPI:1003975988
Name:ASSOCIATES REHAB SOUTH LLC
Entity Type:Organization
Organization Name:ASSOCIATES REHAB SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-621-2116
Mailing Address - Street 1:5190 NW 167TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6328
Mailing Address - Country:US
Mailing Address - Phone:305-621-2116
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33014-6328
Practice Address - Country:US
Practice Address - Phone:305-621-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684883Medicare ID - Type UnspecifiedCORF