1235781436 NPI number — SAN FERNANDO SUBACUTE REHABILITATION CENTER LLC

Table of content: (NPI 1235781436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235781436 NPI number — SAN FERNANDO SUBACUTE REHABILITATION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN FERNANDO SUBACUTE REHABILITATION CENTER LLC
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:
1235781436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13347 VENTURA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91423-4267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-385-3200
Provider Business Mailing Address Fax Number:
818-385-3275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12260 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-899-9545
Provider Business Practice Location Address Fax Number:
818-890-2142
Provider Enumeration Date:
07/09/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
818-370-4390

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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