Provider Demographics
NPI:1417608613
Name:CMR REHAB CENTER OF BURBANK, LLC
Entity Type:Organization
Organization Name:CMR REHAB CENTER OF BURBANK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-761-9659
Mailing Address - Street 1:11770 WARNER AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2661
Mailing Address - Country:US
Mailing Address - Phone:747-699-7500
Mailing Address - Fax:
Practice Address - Street 1:3500 W OLIVE AVE # 300
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4628
Practice Address - Country:US
Practice Address - Phone:747-699-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRESCENT MOON RECOVERY - ORANGE COUNTY IOP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility