Provider Demographics
NPI:1083891683
Name:MIDLAND OUTPATIENT REHAB FACILITY
Entity Type:Organization
Organization Name:MIDLAND OUTPATIENT REHAB FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:AVRIL
Authorized Official - Last Name:SEALY-BAYOH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:305-305-5005
Mailing Address - Street 1:5775 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6269
Mailing Address - Country:US
Mailing Address - Phone:305-305-5005
Mailing Address - Fax:305-235-0383
Practice Address - Street 1:5775 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6269
Practice Address - Country:US
Practice Address - Phone:305-305-5005
Practice Address - Fax:305-235-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684545Medicare Oscar/Certification