Provider Demographics
NPI:1487725420
Name:MIRACLE GROUP REHABILITATION CENTER INC
Entity type:Organization
Organization Name:MIRACLE GROUP REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL REAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-0335
Mailing Address - Street 1:8332 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4180
Mailing Address - Country:US
Mailing Address - Phone:305-262-0335
Mailing Address - Fax:305-262-0832
Practice Address - Street 1:8332 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4180
Practice Address - Country:US
Practice Address - Phone:305-262-0335
Practice Address - Fax:305-262-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL460732-2174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686628Medicare ID - Type UnspecifiedREHABILITATION CENTER