Provider Demographics
NPI:1255511366
Name:HEALTH AMERICA REHABILITATION CENTER OF WAUCHULA LLC
Entity type:Organization
Organization Name:HEALTH AMERICA REHABILITATION CENTER OF WAUCHULA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REINIER
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-370-7094
Mailing Address - Street 1:1830 NW 7TH ST
Mailing Address - Street 2:#225
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3569
Mailing Address - Country:US
Mailing Address - Phone:305-215-4800
Mailing Address - Fax:
Practice Address - Street 1:1830 NW 7TH ST
Practice Address - Street 2:#225
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3569
Practice Address - Country:US
Practice Address - Phone:305-215-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103216Medicare Oscar/Certification