1891094827 NPI number — MACLAY REHABILITATION CENTER, INC.

Table of content: DR. MAGGIE ESTELLE KING OD (NPI 1275192874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891094827 NPI number — MACLAY REHABILITATION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACLAY REHABILITATION CENTER, 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:
1891094827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13370 SAYRE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLMAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-362-5615
Provider Business Mailing Address Fax Number:
818-362-6052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13370 SAYRE ST.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-362-5615
Provider Business Practice Location Address Fax Number:
818-362-6052
Provider Enumeration Date:
03/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CRAGIN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OPERATION DIRECTOR
Authorized Official Telephone Number:
818-362-5615

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  190338AN , 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)





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