Provider Demographics
NPI:1568847481
Name:ADVANCED REHAB GROUP, INC.
Entity type:Organization
Organization Name:ADVANCED REHAB GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-444-0114
Mailing Address - Street 1:3899 NW 7TH ST
Mailing Address - Street 2:224
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5551
Mailing Address - Country:US
Mailing Address - Phone:305-444-0114
Mailing Address - Fax:305-444-0113
Practice Address - Street 1:3899 NW 7TH ST
Practice Address - Street 2:224
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5551
Practice Address - Country:US
Practice Address - Phone:305-444-0114
Practice Address - Fax:305-444-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9695261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)