Provider Demographics
NPI:1164033718
Name:GREENACRES HEALTH & REHAB LLC
Entity Type:Organization
Organization Name:GREENACRES HEALTH & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-964-9331
Mailing Address - Street 1:4010 S 57TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4301
Mailing Address - Country:US
Mailing Address - Phone:561-964-9331
Mailing Address - Fax:
Practice Address - Street 1:4010 S 57TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4301
Practice Address - Country:US
Practice Address - Phone:561-964-9331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty