Provider Demographics
NPI:1497849640
Name:AALLIANCE REHAB INC
Entity Type:Organization
Organization Name:AALLIANCE REHAB INC
Other - Org Name:ALLIANCE REHAB CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARQUIMEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:321-506-4830
Mailing Address - Street 1:878 N MIRAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3054
Mailing Address - Country:US
Mailing Address - Phone:321-506-4830
Mailing Address - Fax:321-473-8744
Practice Address - Street 1:200 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3519
Practice Address - Country:US
Practice Address - Phone:321-506-4830
Practice Address - Fax:321-473-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL686669261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686669Medicare ID - Type UnspecifiedOUTPATIENT REHAB FACILITY