Provider Demographics
NPI:1487687455
Name:SOUTHERN CALIFORNIA REHABILITATION MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA REHABILITATION MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIRNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-847-3200
Mailing Address - Street 1:PO BOX 5171
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91308-5171
Mailing Address - Country:US
Mailing Address - Phone:818-847-3200
Mailing Address - Fax:818-847-3205
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:5TH FLOOR NORTH TOWER
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-847-3200
Practice Address - Fax:818-847-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G680740Medicaid
CA00G680740Medicaid
CAW4111Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER