1043341407 NPI number — FLORIDA REHABILITATION CENTER OF BROWARD COUNTY INC

Table of content: (NPI 1043341407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043341407 NPI number — FLORIDA REHABILITATION CENTER OF BROWARD COUNTY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA REHABILITATION CENTER OF BROWARD COUNTY 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:
1043341407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5504 NW 77TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33067-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-473-6473
Provider Business Mailing Address Fax Number:
954-345-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3591 N ANDREWS AVE
Provider Second Line Business Practice Location Address:
SUITE 5E
Provider Business Practice Location Address City Name:
OAKLAND PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-5289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-473-6473
Provider Business Practice Location Address Fax Number:
954-345-3411
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WADHWA
Authorized Official First Name:
ASHWANI
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
ADM
Authorized Official Telephone Number:
954-473-6473

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3666 , 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)





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