Provider Demographics
NPI:1831432160
Name:ELITE REHAB&MEDICAL CENTER CORP.
Entity type:Organization
Organization Name:ELITE REHAB&MEDICAL CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-979-6178
Mailing Address - Street 1:4355 W 16TH AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7670
Mailing Address - Country:US
Mailing Address - Phone:305-979-6178
Mailing Address - Fax:
Practice Address - Street 1:4355 W 16TH AVE STE 212
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7670
Practice Address - Country:US
Practice Address - Phone:305-979-6178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service