Provider Demographics
NPI:1659504199
Name:SELEST HEALTH CENTER, INC
Entity Type:Organization
Organization Name:SELEST HEALTH CENTER, INC
Other - Org Name:SELECT MEDICAL CLINIC, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-554-2891
Mailing Address - Street 1:16601 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3607
Mailing Address - Country:US
Mailing Address - Phone:305-956-2707
Mailing Address - Fax:305-956-9079
Practice Address - Street 1:16601 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3607
Practice Address - Country:US
Practice Address - Phone:305-956-2707
Practice Address - Fax:305-956-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5314261Q00000X
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC5314OtherAHCA LICENSE