Provider Demographics
NPI:1417229725
Name:CELEBRITY REHAB INC
Entity Type:Organization
Organization Name:CELEBRITY REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-515-9771
Mailing Address - Street 1:50 NW 15TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4266
Mailing Address - Country:US
Mailing Address - Phone:786-515-9771
Mailing Address - Fax:305-248-2780
Practice Address - Street 1:50 NW 15TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4266
Practice Address - Country:US
Practice Address - Phone:786-515-9771
Practice Address - Fax:305-248-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9589111N00000X
FLME28403170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty