Provider Demographics
NPI:1215977178
Name:PALMETTO WEST REHABILITATION CENTER INC
Entity type:Organization
Organization Name:PALMETTO WEST REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVERRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-9869
Mailing Address - Street 1:6955 NW 77TH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2852
Mailing Address - Country:US
Mailing Address - Phone:305-863-9869
Mailing Address - Fax:305-863-9871
Practice Address - Street 1:6955 NW 77TH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-2852
Practice Address - Country:US
Practice Address - Phone:305-863-9869
Practice Address - Fax:305-863-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686812Medicare Oscar/Certification