1639618218 NPI number — CALIFORNIA REHAB CAMPUS 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 1639618218 NPI number — CALIFORNIA REHAB CAMPUS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA REHAB CAMPUS 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:
1639618218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34270 PACIFIC COAST HWY STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-2847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-877-2419
Provider Business Mailing Address Fax Number:
499-308-7789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33861 GRANADA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANA POINT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-272-7342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DUENSING
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
949-877-2419

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  300039AP , 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)

  • Identifier: 656620 . This is a "THE JOINT COMMISSION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300036CP . This is a "DEPARTMENT OF HEALTH CARE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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