Provider Demographics
NPI:1366446916
Name:NOVACARE OUTPATIENT REHABILITATION OF CALIFORNIA INC
Entity Type:Organization
Organization Name:NOVACARE OUTPATIENT REHABILITATION OF CALIFORNIA INC
Other - Org Name:NOVACARE OUTPATIENT REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-782-1212
Mailing Address - Street 1:1090 SUNRISE AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4466
Mailing Address - Country:US
Mailing Address - Phone:916-782-1212
Mailing Address - Fax:916-773-1481
Practice Address - Street 1:1211 N DUTTON AVE
Practice Address - Street 2:STE G
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4638
Practice Address - Country:US
Practice Address - Phone:707-579-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-6614Medicare ID - Type Unspecified