Healthcare Provider Details

I. General information

NPI: 1255005658
Provider Name (Legal Business Name): PSYCHOSOCIAL REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9827 E HIBISCUS ST
PALMETTO BAY FL
33157-5406
US

IV. Provider business mailing address

5711 S DIXIE HWY
SOUTH MIAMI FL
33143-3694
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-1036
  • Fax: 305-667-4938
Mailing address:
  • Phone: 305-667-1036
  • Fax: 305-667-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTA L SANCHEZ
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 305-667-1036