Provider Demographics
NPI:1164880407
Name:SOUTH PACIFIC REHABILITATION SERVICES
Entity Type:Organization
Organization Name:SOUTH PACIFIC REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HILLARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-292-8467
Mailing Address - Street 1:15906 PARKHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-6501
Mailing Address - Country:US
Mailing Address - Phone:909-292-8467
Mailing Address - Fax:
Practice Address - Street 1:15906 PARKHOUSE DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-6501
Practice Address - Country:US
Practice Address - Phone:909-292-8467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility