Provider Demographics
NPI:1790025971
Name:PEDIATRIC REHABILITATION CARE GROUP LLC
Entity Type:Organization
Organization Name:PEDIATRIC REHABILITATION CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-488-4582
Mailing Address - Street 1:1840 W 49TH ST
Mailing Address - Street 2:SUITE #604A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2942
Mailing Address - Country:US
Mailing Address - Phone:786-488-4582
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:786-488-4582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT9975227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty