Provider Demographics
NPI:1588782957
Name:NEUROLOGICAL REHABILITATION CENTER PROGRAM SERVICES
Entity type:Organization
Organization Name:NEUROLOGICAL REHABILITATION CENTER PROGRAM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:AYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:954-722-2110
Mailing Address - Street 1:7777 N UNIVERSITY DR STE 101S
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6106
Mailing Address - Country:US
Mailing Address - Phone:954-722-2110
Mailing Address - Fax:954-722-2304
Practice Address - Street 1:7777 N UNIVERSITY DR STE 101S
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6106
Practice Address - Country:US
Practice Address - Phone:954-722-2110
Practice Address - Fax:954-722-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation