Provider Demographics
NPI:1376324467
Name:SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-631-8004
Mailing Address - Street 1:2610 INDUSTRY WAY STE A
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4028
Mailing Address - Country:US
Mailing Address - Phone:310-631-8004
Mailing Address - Fax:323-905-1938
Practice Address - Street 1:8750 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4830
Practice Address - Country:US
Practice Address - Phone:310-631-8004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health