Provider Demographics
NPI:1275579674
Name:ANGELS REHABILITATION CENTER CORP
Entity Type:Organization
Organization Name:ANGELS REHABILITATION CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIESTEBAN DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-507-1465
Mailing Address - Street 1:5001 SW 74TH CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4483
Mailing Address - Country:US
Mailing Address - Phone:786-507-1465
Mailing Address - Fax:786-507-1184
Practice Address - Street 1:5001 SW 74TH CT
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4483
Practice Address - Country:US
Practice Address - Phone:786-507-1465
Practice Address - Fax:786-507-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN