1316009202 NPI number — INNOVATIVE SENIOR REHABILITATION SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316009202 NPI number — INNOVATIVE SENIOR REHABILITATION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE SENIOR REHABILITATION SERVICES, 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:
6
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:
1316009202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95240-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-368-1009
Provider Business Mailing Address Fax Number:
209-368-1024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9325 E STOCKTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95624-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-685-4550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HADLEY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
VP CFO
Authorized Official Telephone Number:
916-690-0757

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com