Provider Demographics
NPI:1275886384
Name:EM REHABILITATION CENTER
Entity Type:Organization
Organization Name:EM REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:SR
Authorized Official - Credentials:O
Authorized Official - Phone:305-554-5686
Mailing Address - Street 1:8420 W FLAGLER ST STE 218A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2046
Mailing Address - Country:US
Mailing Address - Phone:305-554-5686
Mailing Address - Fax:305-554-5680
Practice Address - Street 1:8420 W FLAGLER ST STE 218A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2046
Practice Address - Country:US
Practice Address - Phone:305-554-5686
Practice Address - Fax:305-554-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 8713261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherMEDICAL OFFICE