Provider Demographics
NPI:1760937981
Name:MEDICAL & REHAB OF HILLSBOROUGH INC
Entity Type:Organization
Organization Name:MEDICAL & REHAB OF HILLSBOROUGH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-443-8221
Mailing Address - Street 1:PO BOX 151686
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-1686
Mailing Address - Country:US
Mailing Address - Phone:813-443-8221
Mailing Address - Fax:813-443-1869
Practice Address - Street 1:2916 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1869
Practice Address - Country:US
Practice Address - Phone:813-443-8221
Practice Address - Fax:813-443-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 261QM0801X
FLHCC10384261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC10384OtherAGENCY FOR HEALTH CARE ADMINISTRATION
FL109961000Medicaid