Provider Demographics
NPI:1518239185
Name:LIGHT REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:LIGHT REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ MURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-429-4176
Mailing Address - Street 1:3060 JOG RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2052
Mailing Address - Country:US
Mailing Address - Phone:561-429-4176
Mailing Address - Fax:
Practice Address - Street 1:3060 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2052
Practice Address - Country:US
Practice Address - Phone:561-429-4176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105283273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME105283OtherSTATE LICENSE