Provider Demographics
NPI:1619203833
Name:AUTHORITY REHABILITATION CENTER
Entity Type:Organization
Organization Name:AUTHORITY REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:786-360-1642
Mailing Address - Street 1:4800 W FLAGLER ST STE 218
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1402
Mailing Address - Country:US
Mailing Address - Phone:786-360-1642
Mailing Address - Fax:786-360-1682
Practice Address - Street 1:4800 W FLAGLER ST STE 218
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1402
Practice Address - Country:US
Practice Address - Phone:786-360-1642
Practice Address - Fax:786-360-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 54662261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center