Provider Demographics
NPI:1689697617
Name:MIAMI GRAND REHABILITATION CENTER
Entity type:Organization
Organization Name:MIAMI GRAND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-2676
Mailing Address - Street 1:6135 NW 167TH ST
Mailing Address - Street 2:SUITE E28
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4338
Mailing Address - Country:US
Mailing Address - Phone:305-649-2676
Mailing Address - Fax:305-643-1946
Practice Address - Street 1:6135 NW 167TH ST
Practice Address - Street 2:SUITE E28
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4338
Practice Address - Country:US
Practice Address - Phone:305-649-2676
Practice Address - Fax:305-643-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684813Medicare ID - Type Unspecified