Provider Demographics
NPI:1164698296
Name:ULTIMATECARE REHAB & WELLNESS INSTITUTE, LLC
Entity Type:Organization
Organization Name:ULTIMATECARE REHAB & WELLNESS INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:561-495-6911
Mailing Address - Street 1:5341 W ATLANTIC AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8166
Mailing Address - Country:US
Mailing Address - Phone:561-495-6911
Mailing Address - Fax:561-495-6910
Practice Address - Street 1:5341 W ATLANTIC AVE STE 303
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8166
Practice Address - Country:US
Practice Address - Phone:561-495-6911
Practice Address - Fax:561-495-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22428261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty