1801072889 NPI number — COMPLETE REHAB & MEDICAL CENTER OF PLANTATION

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 1801072889 NPI number — COMPLETE REHAB & MEDICAL CENTER OF PLANTATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE REHAB & MEDICAL CENTER OF PLANTATION
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:
1801072889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33474-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-916-1133
Provider Business Mailing Address Fax Number:
954-916-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10017 CLEARY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-916-1133
Provider Business Practice Location Address Fax Number:
954-916-0096
Provider Enumeration Date:
01/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAUER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-818-8283

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH7646 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: MA4021 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0400X , with the licence number: CH7924 , 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: 1568668705 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1487877528 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1699971895 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".