Provider Demographics
NPI:1174526743
Name:PSYCHOSOCIAL REHABILITATION CENTER INC
Entity type:Organization
Organization Name:PSYCHOSOCIAL REHABILITATION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:JULIANA
Authorized Official - Last Name:SMITH HOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-667-1036
Mailing Address - Street 1:5711 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3602
Mailing Address - Country:US
Mailing Address - Phone:305-667-1036
Mailing Address - Fax:305-667-4938
Practice Address - Street 1:5711 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3602
Practice Address - Country:US
Practice Address - Phone:305-667-1036
Practice Address - Fax:305-667-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060333300Medicaid
FL141562000Medicaid
FL060333302Medicaid
FL060333317Medicaid
FL060333301Medicaid