Provider Demographics
NPI:1710220223
Name:GLGV REHABILITATION CENTER CORP
Entity Type:Organization
Organization Name:GLGV REHABILITATION CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:786-227-4720
Mailing Address - Street 1:3750 W 16TH AVE STE 244U
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4664
Mailing Address - Country:US
Mailing Address - Phone:786-227-4720
Mailing Address - Fax:
Practice Address - Street 1:3750 W 16TH AVE STE 244U
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4664
Practice Address - Country:US
Practice Address - Phone:786-227-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9603261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service