Provider Demographics
NPI:1295783454
Name:IDEAL REHABILITATION INSTTUTE
Entity type:Organization
Organization Name:IDEAL REHABILITATION INSTTUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPDEVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-987-4747
Mailing Address - Street 1:1800 W 49TH ST
Mailing Address - Street 2:SUITE 126
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2900
Mailing Address - Country:US
Mailing Address - Phone:305-824-0036
Mailing Address - Fax:305-824-0008
Practice Address - Street 1:1800 W 49TH ST
Practice Address - Street 2:SUITE 126
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2900
Practice Address - Country:US
Practice Address - Phone:305-824-0036
Practice Address - Fax:305-824-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683223Medicare ID - Type UnspecifiedCORF