1184025074 NPI number — REHAB OF FRESNO ASSISTED LIVING, LLC

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 1184025074 NPI number — REHAB OF FRESNO ASSISTED LIVING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB OF FRESNO ASSISTED LIVING, 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:
1184025074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90036-5013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-330-6500
Provider Business Mailing Address Fax Number:
866-603-3566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1665 M ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93721-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-268-5362
Provider Business Practice Location Address Fax Number:
559-268-8228
Provider Enumeration Date:
09/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RECHNITZ
Authorized Official First Name:
SHLOMO
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
323-634-1940

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  107206544 , 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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