Healthcare Provider Details

I. General information

NPI: 1295087773
Provider Name (Legal Business Name): ADVANCE REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 149 SEC MATRUYA BARRIO RIO ARRIBA
MANATI PR
00674
US

IV. Provider business mailing address

VILLA EVANGELINA # J9 NUMERO 36
MANATI PR
00674-6101
US

V. Phone/Fax

Practice location:
  • Phone: 787-515-7430
  • Fax:
Mailing address:
  • Phone: 787-515-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number312985
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier312985
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerREGISTRO

VIII. Authorized Official

Name: MR. GERMAN R BERGOLLO ESPINO
Title or Position: PRESIDENTE
Credential:
Phone: 787-515-7430