Provider Demographics
NPI:1629388947
Name:FLORIDA REHABILITATION MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:FLORIDA REHABILITATION MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-582-6808
Mailing Address - Street 1:1926 10TH AVE N STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3300
Mailing Address - Country:US
Mailing Address - Phone:561-582-6808
Mailing Address - Fax:
Practice Address - Street 1:1926 10TH AVE N STE 103
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3300
Practice Address - Country:US
Practice Address - Phone:561-582-6808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8903273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8903OtherAHCA LICENSE NR
FLME 101677OtherMEDICAL LICENSE
FLWCJXC1-BMedicare UPIN