MEDICARE: ELITE REHAB&MEDICAL CENTER CORP.

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	261QH0100X	Health Service Clinic/Center		FL

General Provider Information

NPI Number	:	1831432160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE REHAB&MEDICAL CENTER CORP.

Provider Business Mailing Address
First Line	:	4355 W 16TH AVE STE 212
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7670
Country	:	US
Telephone Number	:	305-979-6178
Fax Number	:

Provider Business Practice Location Address
First Line	:	4355 W 16TH AVE STE 212
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7670
Country	:	US
Telephone Number	:	305-979-6178
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOEL A QUINTANA
Credential	:	LMT
Telephone Number	:	305-979-6178

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	04/29/2013

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