Provider Demographics
NPI:1912206772
Name:PREMIER REHABILITATION GROUP, LLC
Entity Type:Organization
Organization Name:PREMIER REHABILITATION GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-822-6812
Mailing Address - Street 1:7980 NW 155TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5884
Mailing Address - Country:US
Mailing Address - Phone:305-822-6812
Mailing Address - Fax:305-822-6813
Practice Address - Street 1:7980 NW 155TH ST
Practice Address - Street 2:STE A
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5884
Practice Address - Country:US
Practice Address - Phone:305-822-6812
Practice Address - Fax:305-822-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM26565261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation