1164764411 NPI number — PALMETTO REHABILITATION SERVICES, INC

Table of content: MR. DOREAN BURKES HIGH SCHOOL DIPLOMA (NPI 1972445088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164764411 NPI number — PALMETTO REHABILITATION SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO REHABILITATION SERVICES, 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:
1164764411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12420 SW 192ND TER
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:
33177-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-301-4464
Provider Business Mailing Address Fax Number:
786-429-1701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7805 CORAL WAY
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-6539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-301-4464
Provider Business Practice Location Address Fax Number:
786-429-1701
Provider Enumeration Date:
03/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MONTANEZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
SAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-301-4464

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com