Provider Demographics
NPI:1528407400
Name:RENAISSANCE REHAB CENTER INC.
Entity Type:Organization
Organization Name:RENAISSANCE REHAB CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-549-8517
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:305-549-8517
Mailing Address - Fax:305-549-8516
Practice Address - Street 1:8660 W FLAGLER ST
Practice Address - Street 2:203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2031
Practice Address - Country:US
Practice Address - Phone:305-549-8517
Practice Address - Fax:305-549-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA71838261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy