Provider Demographics
NPI:1205394392
Name:PREMIUM REHABILITATION OF MIAMI INC
Entity Type:Organization
Organization Name:PREMIUM REHABILITATION OF MIAMI INC
Other - Org Name:ANM MENTAL HEALTH THERAPY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-495-1622
Mailing Address - Street 1:590 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2906
Mailing Address - Country:US
Mailing Address - Phone:305-987-0807
Mailing Address - Fax:
Practice Address - Street 1:530 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3605
Practice Address - Country:US
Practice Address - Phone:305-497-2239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center