Provider Demographics
NPI:1790706984
Name:WITCORF, INC.
Entity Type:Organization
Organization Name:WITCORF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISHKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WITTELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-368-1755
Mailing Address - Street 1:1085 KANE CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2105
Mailing Address - Country:US
Mailing Address - Phone:305-962-7155
Mailing Address - Fax:305-861-5558
Practice Address - Street 1:1085 KANE CONCOURSE
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2105
Practice Address - Country:US
Practice Address - Phone:305-962-7155
Practice Address - Fax:305-861-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104876273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104876Medicare ID - Type UnspecifiedCORF