Provider Demographics
NPI:1295087773
Name:ADVANCE REHABILITATION CENTER INC
Entity type:Organization
Organization Name:ADVANCE REHABILITATION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERGOLLO ESPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-515-7430
Mailing Address - Street 1:VILLA EVANGELINA # J9
Mailing Address - Street 2:NUMERO 36
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-6101
Mailing Address - Country:US
Mailing Address - Phone:787-515-7430
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 149 SEC MATRUYA
Practice Address - Street 2:BARRIO RIO ARRIBA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-515-7430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR312985314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR312985OtherREGISTRO