Provider Demographics
NPI:1700902160
Name:ADVANCE REHAB SERVICES P A
Entity Type:Organization
Organization Name:ADVANCE REHAB SERVICES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:954-748-7555
Mailing Address - Street 1:7471 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4921
Mailing Address - Country:US
Mailing Address - Phone:954-748-7555
Mailing Address - Fax:954-748-4910
Practice Address - Street 1:7471 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4921
Practice Address - Country:US
Practice Address - Phone:954-748-7555
Practice Address - Fax:954-748-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP.T. 0003694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881552600Medicaid
FL881552600Medicaid