=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275695926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERGLADES REHAB CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2006
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5050 NW 74TH AVE SUITE H
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-477-5999
-----------------------------------------------------
Fax | 305-477-5995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5050 NW 74TH AVE SUITE H
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-477-5999
-----------------------------------------------------
Fax | 305-477-5995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARISTIDES BERENGUER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-225-4666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------