Provider Demographics
NPI:1720017668
Name:SOUTHERN CORF, INC.
Entity Type:Organization
Organization Name:SOUTHERN CORF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-554-3854
Mailing Address - Street 1:770 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2065
Mailing Address - Country:US
Mailing Address - Phone:305-774-4644
Mailing Address - Fax:305-774-4648
Practice Address - Street 1:770 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2065
Practice Address - Country:US
Practice Address - Phone:305-774-4644
Practice Address - Fax:305-774-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104832Medicare ID - Type UnspecifiedPROVIDER NUMBER