MEDICARE: ROYAL COAST REHABILITATION CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	HCC4779	FL

General Provider Information

NPI Number	:	1386678332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL COAST REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	11200 W FLAGLER ST
Second Line	:	SUITE 101
City	:	MIAMI
State	:	FL
Zip	:	33174-4210
Country	:	US
Telephone Number	:	305-445-8787
Fax Number	:	305-445-2747

Provider Business Practice Location Address
First Line	:	11200 W FLAGLER ST
Second Line	:	SUITE 101
City	:	MIAMI
State	:	FL
Zip	:	33174-4210
Country	:	US
Telephone Number	:	305-445-8787
Fax Number	:	305-445-2747

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. ELIZABETH VALENCIA
Credential	:
Telephone Number	:	305-445-8787

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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