Provider Demographics
NPI:1871888404
Name:QUALITY LIFE REHABILITACION CENTER
Entity type:Organization
Organization Name:QUALITY LIFE REHABILITACION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGULERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-819-8755
Mailing Address - Street 1:7760 W 20TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1829
Mailing Address - Country:US
Mailing Address - Phone:305-819-8755
Mailing Address - Fax:305-819-8740
Practice Address - Street 1:7760 W 20TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1829
Practice Address - Country:US
Practice Address - Phone:305-819-8755
Practice Address - Fax:305-819-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM26793261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation