1871104729 NPI number — CENTER FOR AGING AND REHABILITATION OF MIAMI GARDENS INC

Table of content: KATHERINE VIGIL MS SLP (NPI 1679706337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871104729 NPI number — CENTER FOR AGING AND REHABILITATION OF MIAMI GARDENS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR AGING AND REHABILITATION OF MIAMI GARDENS 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:
6
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:
1871104729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SE 2ND ST STE 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33131-2101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-367-4597
Provider Business Mailing Address Fax Number:
954-367-4564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 NE 191ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33179-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-651-9690
Provider Business Practice Location Address Fax Number:
305-654-9123
Provider Enumeration Date:
08/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT DIRECTOR
Authorized Official Telephone Number:
954-367-4597

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107876600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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