=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144644477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 5-STAR REHABILITATION CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2014
-----------------------------------------------------
Last Update Date | 03/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 W 49TH ST STE 406
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-632-9523
-----------------------------------------------------
Fax | 305-901-5225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 W 49TH ST STE 406
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-632-9523
-----------------------------------------------------
Fax | 305-901-5225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GEORGINA ARES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-632-9523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | HCC7235
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------