Provider Demographics
NPI:1114095080
Name:ODD-FELLOW REBEKAH CHILDREN'S HOME OF CALIFORNIA
Entity Type:Organization
Organization Name:ODD-FELLOW REBEKAH CHILDREN'S HOME OF CALIFORNIA
Other - Org Name:REBEKAH CHILDREN'S SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHE
Authorized Official - Middle Name:
Authorized Official - Last Name:REBBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-846-2106
Mailing Address - Street 1:290 I O O F AVE
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5204
Mailing Address - Country:US
Mailing Address - Phone:408-846-2100
Mailing Address - Fax:408-846-2495
Practice Address - Street 1:290 I O O F AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5204
Practice Address - Country:US
Practice Address - Phone:408-846-2125
Practice Address - Fax:408-846-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8367OtherMED-CAL NUMBER