Healthcare Provider Details

I. General information

NPI: 1831494467
Provider Name (Legal Business Name): RAINBOW REHAB & MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8302 NW 103RD ST 202
HIALEAH GARDENS FL
33016-4697
US

IV. Provider business mailing address

8302 NW 103RD ST 202
HIALEAH GARDENS FL
33016-4697
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-4754
  • Fax: 786-414-0561
Mailing address:
  • Phone: 786-953-4754
  • Fax: 786-414-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOEL CHAVEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-953-4754