Provider Demographics
NPI:1508895707
Name:VILLA MARIA REHAB, INC
Entity Type:Organization
Organization Name:VILLA MARIA REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MANUELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-228-1440
Mailing Address - Street 1:13780 SW 26TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6302
Mailing Address - Country:US
Mailing Address - Phone:305-228-1440
Mailing Address - Fax:305-228-1441
Practice Address - Street 1:13780 SW 26TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6302
Practice Address - Country:US
Practice Address - Phone:305-228-1440
Practice Address - Fax:305-228-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683213Medicare PIN