Provider Demographics
NPI:1033860390
Name:ACL HEALTH CENTER CORP
Entity Type:Organization
Organization Name:ACL HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMBER
Authorized Official - Middle Name:MEDINA
Authorized Official - Last Name:RAMENTOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-208-6744
Mailing Address - Street 1:2721 SW 137TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2721 SW 137TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6355
Practice Address - Country:US
Practice Address - Phone:786-208-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13215OtherAHCA