Provider Demographics
NPI:1225047426
Name:PREMIER REHAB SERVICES LLC
Entity Type:Organization
Organization Name:PREMIER REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-698-8760
Mailing Address - Street 1:3750 W 16TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4654
Mailing Address - Country:US
Mailing Address - Phone:305-698-8760
Mailing Address - Fax:305-698-8780
Practice Address - Street 1:3750 W 16TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4654
Practice Address - Country:US
Practice Address - Phone:305-698-8760
Practice Address - Fax:305-698-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684808Medicare ID - Type UnspecifiedCORF