Provider Demographics
NPI:1265691356
Name:PAIN RELIEF REHAB MEDICAL CENTER,CORP
Entity type:Organization
Organization Name:PAIN RELIEF REHAB MEDICAL CENTER,CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCENCION
Authorized Official - Suffix:X
Authorized Official - Credentials:ETC
Authorized Official - Phone:305-821-2530
Mailing Address - Street 1:3750 W 16TH AVE
Mailing Address - Street 2:SUITE#104
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4654
Mailing Address - Country:US
Mailing Address - Phone:305-821-2530
Mailing Address - Fax:305-821-2968
Practice Address - Street 1:3750 W 16TH AVE
Practice Address - Street 2:SUITE#104
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4654
Practice Address - Country:US
Practice Address - Phone:305-821-2530
Practice Address - Fax:305-821-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8097261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service