=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013983535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRACARE REHABILITATION AGENCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2006
-----------------------------------------------------
Last Update Date | 11/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 W HILLSBORO BLVD
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33442-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-531-1472
-----------------------------------------------------
Fax | 954-531-1473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 SE 6TH AVE STE B
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-330-8451
-----------------------------------------------------
Fax | 561-330-8461
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DANA PUSATERI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-330-8451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------