Provider Demographics
NPI:1134703820
Name:RESERVA REHAB CENTER
Entity Type:Organization
Organization Name:RESERVA REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEY VILLAZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-660-5743
Mailing Address - Street 1:1414 NW 107TH AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2743
Mailing Address - Country:US
Mailing Address - Phone:786-608-8580
Mailing Address - Fax:
Practice Address - Street 1:1414 NW 107TH AVE STE 410
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2743
Practice Address - Country:US
Practice Address - Phone:786-608-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty