Provider Demographics
NPI:1982879615
Name:BLUE REHAB CENTER CORP
Entity Type:Organization
Organization Name:BLUE REHAB CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-331-8214
Mailing Address - Street 1:7392 NW 35TH TER
Mailing Address - Street 2:206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1271
Mailing Address - Country:US
Mailing Address - Phone:786-331-8214
Mailing Address - Fax:786-331-8215
Practice Address - Street 1:7392 NW 35TH TER
Practice Address - Street 2:206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:786-331-8214
Practice Address - Fax:786-331-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6302261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC6302OtherAHCA LICENSE