Provider Demographics
NPI:1922670496
Name:CHILDRENS REHAB LLC
Entity Type:Organization
Organization Name:CHILDRENS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLEIDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-499-5497
Mailing Address - Street 1:2727 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4406
Mailing Address - Country:US
Mailing Address - Phone:305-622-7575
Mailing Address - Fax:305-622-9464
Practice Address - Street 1:2727 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4406
Practice Address - Country:US
Practice Address - Phone:305-622-7575
Practice Address - Fax:305-622-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center