Provider Demographics
NPI:1295817344
Name:PRIME QUALITY REHAB INC
Entity Type:Organization
Organization Name:PRIME QUALITY REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAINCHAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-7799
Mailing Address - Street 1:1840 W 49TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2942
Mailing Address - Country:US
Mailing Address - Phone:305-828-7799
Mailing Address - Fax:305-828-7399
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-828-7799
Practice Address - Fax:305-828-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684591Medicare Oscar/Certification