Provider Demographics
NPI:1336173897
Name:ISLAND REHAB CENTER CORP
Entity Type:Organization
Organization Name:ISLAND REHAB CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-798-0723
Mailing Address - Street 1:PO BOX 362652
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2652
Mailing Address - Country:US
Mailing Address - Phone:787-798-0723
Mailing Address - Fax:787-251-7034
Practice Address - Street 1:EXT. HNAS. DAVILA
Practice Address - Street 2:J-13 ST. #2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-0723
Practice Address - Fax:787-251-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0011261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-4502Medicare ID - Type Unspecified