Provider Demographics
NPI:1194848879
Name:ANBERRY PHYSICAL REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:ANBERRY PHYSICAL REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-357-3420
Mailing Address - Street 1:1685 SHAFFER RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-4456
Mailing Address - Country:US
Mailing Address - Phone:209-357-3420
Mailing Address - Fax:209-357-0904
Practice Address - Street 1:1675 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4456
Practice Address - Country:US
Practice Address - Phone:209-357-3420
Practice Address - Fax:209-357-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000070282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55244HMedicaid
CA555244Medicare ID - Type Unspecified