Provider Demographics
NPI:1780018101
Name:VIRGINIA REHABILITATION CORP
Entity Type:Organization
Organization Name:VIRGINIA REHABILITATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCARNACION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-526-0289
Mailing Address - Street 1:6501 NW 36TH ST
Mailing Address - Street 2:SUITE 390
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6959
Mailing Address - Country:US
Mailing Address - Phone:305-526-0289
Mailing Address - Fax:305-526-0291
Practice Address - Street 1:6501 NW 36TH ST
Practice Address - Street 2:SUITE 390
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6959
Practice Address - Country:US
Practice Address - Phone:305-526-0289
Practice Address - Fax:305-526-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10737261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service