Provider Demographics
NPI:1952888612
Name:LEON REHABILITATION AND NURSING SERVICES, INC
Entity Type:Organization
Organization Name:LEON REHABILITATION AND NURSING SERVICES, INC
Other - Org Name:LEON REHABILIATION AND NURSING SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMBRENO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:395-801-0476
Mailing Address - Street 1:6701 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5741
Mailing Address - Country:US
Mailing Address - Phone:305-801-0476
Mailing Address - Fax:
Practice Address - Street 1:6701 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5741
Practice Address - Country:US
Practice Address - Phone:305-801-0476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14440225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community MobilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467769927Medicaid