Provider Demographics
NPI:1013736578
Name:ILLUMINATED RECOVERY & REHABILITATION SERVICES
Entity type:Organization
Organization Name:ILLUMINATED RECOVERY & REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAO
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:RAMOS FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:302-745-2256
Mailing Address - Street 1:20 VALLEY AVE APT A18
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3600
Mailing Address - Country:US
Mailing Address - Phone:302-745-2256
Mailing Address - Fax:
Practice Address - Street 1:20 VALLEY AVE APT A18
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3600
Practice Address - Country:US
Practice Address - Phone:302-745-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty