Provider Demographics
NPI:1114222999
Name:DISCHARGE RESOURCE GROUP
Entity Type:Organization
Organization Name:DISCHARGE RESOURCE GROUP
Other - Org Name:PEDIATRIC RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-885-9000
Mailing Address - Street 1:1150 S BASCOM AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3509
Mailing Address - Country:US
Mailing Address - Phone:408-885-9000
Mailing Address - Fax:408-885-9009
Practice Address - Street 1:1150 S BASCOM AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3509
Practice Address - Country:US
Practice Address - Phone:408-885-9000
Practice Address - Fax:408-885-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54842251P0200X
CA10119225XP0200X
CA17648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty