Provider Demographics
NPI:1669945119
Name:CLEVELAND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:CLEVELAND REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-314-3555
Mailing Address - Street 1:35 BARKLEY CIR STE 1&2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7601
Mailing Address - Country:US
Mailing Address - Phone:239-314-3555
Mailing Address - Fax:239-314-3556
Practice Address - Street 1:35 BARKLEY CIR STE 1&2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7601
Practice Address - Country:US
Practice Address - Phone:239-314-3555
Practice Address - Fax:239-314-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty