Provider Demographics
NPI:1598045478
Name:MIRACLE REHAB CENTER, INC
Entity Type:Organization
Organization Name:MIRACLE REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANESKY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-817-1140
Mailing Address - Street 1:7590 NW 186TH ST
Mailing Address - Street 2:STE 209
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2952
Mailing Address - Country:US
Mailing Address - Phone:305-817-1140
Mailing Address - Fax:
Practice Address - Street 1:7590 NW 186TH ST
Practice Address - Street 2:STE 209
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2952
Practice Address - Country:US
Practice Address - Phone:305-817-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center