1164711339 NPI number — ADVANCED SPINAL REHABILITATION, INC.

Table of content: (NPI 1164711339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164711339 NPI number — ADVANCED SPINAL REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SPINAL REHABILITATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164711339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1585 BUTTE HOUSE RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95993-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-751-9340
Provider Business Mailing Address Fax Number:
530-673-0151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 TWELVE BRIDGES DR
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95648-8815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-209-3484
Provider Business Practice Location Address Fax Number:
916-209-3486
Provider Enumeration Date:
03/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIES
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-209-3484

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)