Provider Demographics
NPI:1508942509
Name:PRECIOUS THERAPY & REHAB CENTER FOR KIDS INC
Entity Type:Organization
Organization Name:PRECIOUS THERAPY & REHAB CENTER FOR KIDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:IDALMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-207-2996
Mailing Address - Street 1:4160 W 16TH AVE
Mailing Address - Street 2:SUITE 210 & 211
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5853
Mailing Address - Country:US
Mailing Address - Phone:305-207-2996
Mailing Address - Fax:305-207-2819
Practice Address - Street 1:4160 W 16TH AVE
Practice Address - Street 2:SUITE 210 & 211
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5853
Practice Address - Country:US
Practice Address - Phone:305-207-2996
Practice Address - Fax:305-207-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686821Medicare Oscar/Certification