MEDICARE: BASIC TREATMENT CENTER CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	599171-7	FL

General Provider Information

NPI Number	:	1790874592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIC TREATMENT CENTER CORP

Provider Business Mailing Address
First Line	:	1051 W 29TH ST
Second Line	:	SUITE 2
City	:	HIALEAH
State	:	FL
Zip	:	33012-5057
Country	:	US
Telephone Number	:	786-237-1715
Fax Number	:	305-631-1180

Provider Business Practice Location Address
First Line	:	1051 W 29TH ST
Second Line	:	SUITE 2
City	:	HIALEAH
State	:	FL
Zip	:	33012-5057
Country	:	US
Telephone Number	:	786-237-1715
Fax Number	:	305-631-1180

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAFAEL RODRIGUEZ
Credential	:
Telephone Number	:	786-237-1715

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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