Provider Demographics
NPI:1386272037
Name:PREMIUM REHAB CENTER GROUP CORP.
Entity type:Organization
Organization Name:PREMIUM REHAB CENTER GROUP CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-203-6689
Mailing Address - Street 1:2826 AVE DOS PALMAS
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4106
Mailing Address - Country:US
Mailing Address - Phone:787-261-5093
Mailing Address - Fax:787-784-9264
Practice Address - Street 1:2826 AVE DOS PALMAS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4106
Practice Address - Country:US
Practice Address - Phone:787-261-5093
Practice Address - Fax:787-784-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy