Provider Demographics
NPI:1871549972
Name:CENTER FOR REHABILITATION OF PALM BEACH LLC
Entity type:Organization
Organization Name:CENTER FOR REHABILITATION OF PALM BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-392-5315
Mailing Address - Street 1:2756 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2546
Mailing Address - Country:US
Mailing Address - Phone:954-395-5315
Mailing Address - Fax:954-392-5317
Practice Address - Street 1:2756 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2546
Practice Address - Country:US
Practice Address - Phone:954-395-5315
Practice Address - Fax:954-392-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
103298Medicare Oscar/Certification