Healthcare Provider Details

I. General information

NPI: 1922670496
Provider Name (Legal Business Name): CHILDRENS REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 NW 167TH ST
MIAMI GARDENS FL
33056-4406
US

IV. Provider business mailing address

2727 NW 167TH ST
MIAMI GARDENS FL
33056-4406
US

V. Phone/Fax

Practice location:
  • Phone: 305-622-7575
  • Fax: 305-622-9464
Mailing address:
  • Phone: 305-622-7575
  • Fax: 305-622-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: YOLEIDIS GONZALEZ
Title or Position: OWNER
Credential:
Phone: 786-499-5497