Provider Demographics
NPI:1780636878
Name:SERVICE MEDICAL REHABILITATION
Entity Type:Organization
Organization Name:SERVICE MEDICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:305-826-5567
Mailing Address - Street 1:3750 W 16TH AVE
Mailing Address - Street 2:SUITE 140 U
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4654
Mailing Address - Country:US
Mailing Address - Phone:305-826-5567
Mailing Address - Fax:305-826-5568
Practice Address - Street 1:3750 W 16TH AVE
Practice Address - Street 2:SUITE 140 U
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4654
Practice Address - Country:US
Practice Address - Phone:305-826-5567
Practice Address - Fax:305-826-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL600195-2261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health