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General NPI Number Information
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NPI Number | 1487934295
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Entity Type | Organization
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Legal Business Name | SUNSHINE REHABILITATION GROUP LLC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 2331 N STATE ROAD 7 124
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-3748
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Country | US
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Telephone | 954-533-2414
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 NORTH STATE ROAD 7 124
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City | LAUDERHILL
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State | FL
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Zip | 33313
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Country | US
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Telephone | 954-533-2414
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RENFORD VALENTINE
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Credential |
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Telephone | 954-533-2414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 321-242518
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License Number State | FL
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