Provider Demographics
NPI:1407143589
Name:CAST RECOVERY SERVICES
Entity Type:Organization
Organization Name:CAST RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVINTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-993-0699
Mailing Address - Street 1:1830 LINCOLN BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4524
Mailing Address - Country:US
Mailing Address - Phone:310-993-0699
Mailing Address - Fax:310-564-1883
Practice Address - Street 1:1830 LINCOLN BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4524
Practice Address - Country:US
Practice Address - Phone:310-993-0699
Practice Address - Fax:310-564-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)