Provider Demographics
NPI:1235468158
Name:DAMEDA REHABILITATION CORP
Entity Type:Organization
Organization Name:DAMEDA REHABILITATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-663-3228
Mailing Address - Street 1:5040 NW 7TH ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3422
Mailing Address - Country:US
Mailing Address - Phone:786-663-3228
Mailing Address - Fax:305-675-2668
Practice Address - Street 1:5040 NW 7TH ST
Practice Address - Street 2:SUITE 710
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3434
Practice Address - Country:US
Practice Address - Phone:786-663-3228
Practice Address - Fax:305-675-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7829261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCERTIFICATE 9130OtherEXEMPT AHCA LICENSE