Provider Demographics
NPI:1811917610
Name:GERIATRIC TREATMENT CENTER INC
Entity type:Organization
Organization Name:GERIATRIC TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-883-8437
Mailing Address - Street 1:709 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4553
Mailing Address - Country:US
Mailing Address - Phone:305-883-8437
Mailing Address - Fax:305-883-8417
Practice Address - Street 1:709 E 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4553
Practice Address - Country:US
Practice Address - Phone:305-883-8437
Practice Address - Fax:305-883-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686782Medicare ID - Type UnspecifiedPROVIDER NUMBER