Provider Demographics
NPI:1053525725
Name:GOOD CARE REHABILITATIVE SERVICE CORP
Entity type:Organization
Organization Name:GOOD CARE REHABILITATIVE SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-476-0102
Mailing Address - Street 1:4880 NW 7TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2102
Mailing Address - Country:US
Mailing Address - Phone:305-476-0102
Mailing Address - Fax:305-476-0908
Practice Address - Street 1:4880 NW 7TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2102
Practice Address - Country:US
Practice Address - Phone:305-476-0102
Practice Address - Fax:305-476-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686560Medicare PIN