Provider Demographics
NPI:1366743718
Name:GLGV REHABILITATION CENTER
Entity type:Organization
Organization Name:GLGV REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-456-1358
Mailing Address - Street 1:1140 W 50TH ST STE 400B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3400
Mailing Address - Country:US
Mailing Address - Phone:305-456-1358
Mailing Address - Fax:305-456-5369
Practice Address - Street 1:1140 W 50TH ST STE 400B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3400
Practice Address - Country:US
Practice Address - Phone:305-456-1358
Practice Address - Fax:305-456-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation