Provider Demographics
NPI:1457815839
Name:GREENACRES INJURY AND REHAB CENTER
Entity Type:Organization
Organization Name:GREENACRES INJURY AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIROJA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGMOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-929-6903
Mailing Address - Street 1:4824 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2208
Mailing Address - Country:US
Mailing Address - Phone:561-929-6903
Mailing Address - Fax:
Practice Address - Street 1:4824 10TH AVE N
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2208
Practice Address - Country:US
Practice Address - Phone:561-929-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center