1487699286 NPI number — GAVY REHABILITATION CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487699286 NPI number — GAVY REHABILITATION CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAVY REHABILITATION CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487699286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6070 W 18TH AVE
Provider Second Line Business Mailing Address:
APT 111
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012-6172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-318-1526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 PALM AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-820-7130
Provider Business Practice Location Address Fax Number:
305-820-7124
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTANA
Authorized Official First Name:
GENOVEVA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-820-7130

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  ME50169 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HC3656 . This is a "AHCA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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