MEDICARE: SOUTHERN CORF, 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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1720017668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CORF, INC.

Provider Business Mailing Address
First Line	:	770 PONCE DE LEON BLVD
Second Line	:	SUITE 1
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2065
Country	:	US
Telephone Number	:	305-774-4644
Fax Number	:	305-774-4648

Provider Business Practice Location Address
First Line	:	770 PONCE DE LEON BLVD
Second Line	:	SUITE 101
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2065
Country	:	US
Telephone Number	:	305-774-4644
Fax Number	:	305-774-4648

Authorized Official
Title or Position	:	CEO
Name	:	ALINA MENDEZ
Credential	:
Telephone Number	:	786-554-3854

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	09/10/2008

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