Provider Demographics
NPI:1497042253
Name:BLUE HEAVEN REHABILITATION INC
Entity Type:Organization
Organization Name:BLUE HEAVEN REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NODARSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-2400
Mailing Address - Street 1:4355 W 16TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7666
Mailing Address - Country:US
Mailing Address - Phone:305-551-2400
Mailing Address - Fax:305-551-3989
Practice Address - Street 1:4355 W 16TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7666
Practice Address - Country:US
Practice Address - Phone:305-551-2400
Practice Address - Fax:305-551-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty