Provider Demographics
NPI:1407381320
Name:REHABILITATION HOSPITAL OF SOUTHERN CALIFORNIA LLC
Entity Type:Organization
Organization Name:REHABILITATION HOSPITAL OF SOUTHERN CALIFORNIA LLC
Other - Org Name:VIBRA REHABILITATION HOSPITAL OF RANCHO MIRAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-2299
Mailing Address - Street 1:1024 N GALLOWAY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2434
Mailing Address - Country:US
Mailing Address - Phone:972-216-2299
Mailing Address - Fax:
Practice Address - Street 1:70077 RAMON RD
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5201
Practice Address - Country:US
Practice Address - Phone:717-620-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital