1548684467 NPI number — 2210 SANTA ANA OPCO, 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 1548684467 NPI number — 2210 SANTA ANA OPCO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
2210 SANTA ANA OPCO, 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:
ADVANCED REHAB CENTER OF TUSTIN
Provider Other Organization Name Type Code:
3
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:
1548684467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11440 VENTURA BLVD
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91604-3154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-985-6600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-985-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GASTWIRTH
Authorized Official First Name:
MANACHEM
Authorized Official Middle Name:
MENDEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
818-915-4900

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)

  • Identifier: ZZT055330J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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