1508802471 NPI number — RECOVERCARE THERAPY GROUP, INC.

Table of content: KATIE ANN VANHOOSEN RN (NPI 1851771935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508802471 NPI number — RECOVERCARE THERAPY GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERCARE THERAPY GROUP, 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:
1508802471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13330 BLOOMFIELD AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90650-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6850 LINCOLN AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUENA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90620-4178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-527-9240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOLLIER
Authorized Official First Name:
MARILOU
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REHAB
Authorized Official Telephone Number:
562-484-3860

Provider Taxonomy Codes

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

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

  • Identifier: W15262A . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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