Provider Demographics
NPI:1396020673
Name:CLEVELAND REHAB CENTER CORP
Entity Type:Organization
Organization Name:CLEVELAND REHAB CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-288-5647
Mailing Address - Street 1:3049 CLEVELAND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7041
Mailing Address - Country:US
Mailing Address - Phone:239-288-5647
Mailing Address - Fax:239-288-5654
Practice Address - Street 1:3049 CLEVELAND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7041
Practice Address - Country:US
Practice Address - Phone:239-288-5647
Practice Address - Fax:239-288-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 9451261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFILE 9821OtherAHCA EXEMPT HCC UNIT