Provider Demographics
NPI:1255005658
Name:PSYCHOSOCIAL REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:PSYCHOSOCIAL REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-667-1036
Mailing Address - Street 1:5711 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3694
Mailing Address - Country:US
Mailing Address - Phone:305-667-1036
Mailing Address - Fax:305-667-4938
Practice Address - Street 1:9827 E HIBISCUS ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5406
Practice Address - Country:US
Practice Address - Phone:305-667-1036
Practice Address - Fax:305-667-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060333317Medicaid