Provider Demographics
NPI:1578542619
Name:CADC CORP - MIRACLE REHAB CENTER
Entity Type:Organization
Organization Name:CADC CORP - MIRACLE REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-266-4048
Mailing Address - Street 1:7944 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4209
Mailing Address - Country:US
Mailing Address - Phone:305-266-4048
Mailing Address - Fax:305-266-4049
Practice Address - Street 1:7944 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4209
Practice Address - Country:US
Practice Address - Phone:305-266-4048
Practice Address - Fax:305-266-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684557Medicare ID - Type Unspecified