Provider Demographics
NPI:1154552784
Name:PROCARE REHABILITATION CENTERS INC
Entity type:Organization
Organization Name:PROCARE REHABILITATION CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-220-9052
Mailing Address - Street 1:9100 CORAL WAY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2076
Mailing Address - Country:US
Mailing Address - Phone:305-220-9052
Mailing Address - Fax:305-220-9926
Practice Address - Street 1:9100 CORAL WAY
Practice Address - Street 2:SUITE 10
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2076
Practice Address - Country:US
Practice Address - Phone:305-220-9052
Practice Address - Fax:305-220-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCY873AMedicare Oscar/Certification