Provider Demographics
NPI:1205044377
Name:PALM REHABILITATION, INC
Entity Type:Organization
Organization Name:PALM REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-821-7383
Mailing Address - Street 1:258 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1855
Mailing Address - Country:US
Mailing Address - Phone:305-821-7383
Mailing Address - Fax:305-821-6404
Practice Address - Street 1:258 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1855
Practice Address - Country:US
Practice Address - Phone:305-821-7383
Practice Address - Fax:305-821-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4235261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC4235OtherAHCA LICENSE