1053649665 NPI number — CENTER FOR HEALTH & INDEPENDENCE REHAB INC

Table of content: (NPI 1053649665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053649665 NPI number — CENTER FOR HEALTH & INDEPENDENCE REHAB INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR HEALTH & INDEPENDENCE REHAB 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:
CHI REHAB
Provider Other Organization Name Type Code:
3
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:
1053649665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94709-0344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-964-0458
Provider Business Mailing Address Fax Number:
510-964-0476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 DWIGHT WAY
Provider Second Line Business Practice Location Address:
ROOM 2350
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-964-0458
Provider Business Practice Location Address Fax Number:
510-964-0476
Provider Enumeration Date:
11/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHI
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-220-4441

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  A95727 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING . This is a "PENDING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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