Healthcare Provider Details

I. General information

NPI: 1316481765
Provider Name (Legal Business Name): LIFECARE REHAB THERAPY OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST SUITE 438
HIALEAH FL
33012-3402
US

IV. Provider business mailing address

900 W 49TH ST STE 424
HIALEAH FL
33012-3487
US

V. Phone/Fax

Practice location:
  • Phone: 786-508-8976
  • Fax:
Mailing address:
  • Phone: 305-639-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: LESTHER FUENTES CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 305-639-8984