Provider Demographics
NPI:1790017366
Name:SOUTH FLORIDA REHAB CENTER OF DEERFIELD BEACH
Entity Type:Organization
Organization Name:SOUTH FLORIDA REHAB CENTER OF DEERFIELD BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDONOV
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:954-420-9499
Mailing Address - Street 1:816 SE 9TH ST STE 2A2B
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5637
Mailing Address - Country:US
Mailing Address - Phone:954-420-9499
Mailing Address - Fax:954-420-9520
Practice Address - Street 1:816 SE 9TH ST STE 2A2B
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5637
Practice Address - Country:US
Practice Address - Phone:954-420-9499
Practice Address - Fax:954-420-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM24255261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation