Provider Demographics
NPI:1528092483
Name:TWO GS OF BROWARD INC
Entity type:Organization
Organization Name:TWO GS OF BROWARD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EIRANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-595-2053
Mailing Address - Street 1:7100 SW 99TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4668
Mailing Address - Country:US
Mailing Address - Phone:305-595-2053
Mailing Address - Fax:305-595-0752
Practice Address - Street 1:7100 SW 99TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4668
Practice Address - Country:US
Practice Address - Phone:305-595-2053
Practice Address - Fax:305-595-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-3240Medicare ID - Type Unspecified