Provider Demographics
NPI:1962422725
Name:ABC TOTAL REHABILITATION CARE
Entity type:Organization
Organization Name:ABC TOTAL REHABILITATION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-819-4004
Mailing Address - Street 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-819-4004
Mailing Address - Fax:305-819-4005
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 302A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-819-4004
Practice Address - Fax:305-819-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8049-153261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684526Medicare ID - Type Unspecified