Provider Demographics
NPI:1538500756
Name:CB PHENIX REHABILITATION CENTER CORP
Entity Type:Organization
Organization Name:CB PHENIX REHABILITATION CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MM
Authorized Official - Phone:305-557-6188
Mailing Address - Street 1:3750 W 16TH AVE
Mailing Address - Street 2:SUITE 226-U
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4654
Mailing Address - Country:US
Mailing Address - Phone:305-557-6188
Mailing Address - Fax:305-557-6199
Practice Address - Street 1:3750 W 16TH AVE
Practice Address - Street 2:SUITE 226-U
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4654
Practice Address - Country:US
Practice Address - Phone:305-557-6188
Practice Address - Fax:305-557-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7764261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service