Provider Demographics
NPI:1770623043
Name:ADVANCE REHABILITATION AND WELLNESS CENTER
Entity type:Organization
Organization Name:ADVANCE REHABILITATION AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-661-1766
Mailing Address - Street 1:6085 SW 40 ST
Mailing Address - Street 2:101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3814
Mailing Address - Country:US
Mailing Address - Phone:305-661-1766
Mailing Address - Fax:305-661-1896
Practice Address - Street 1:6085 SW 40 ST
Practice Address - Street 2:101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3814
Practice Address - Country:US
Practice Address - Phone:305-661-1766
Practice Address - Fax:305-661-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0401X261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC4451Medicare ID - Type UnspecifiedCORF
FL684880Medicare PIN
FL684880Medicare Oscar/Certification