Provider Demographics
NPI:1497966089
Name:A G REHAB CENTER
Entity Type:Organization
Organization Name:A G REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATURVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-929-6260
Mailing Address - Street 1:PO BOX 6755
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-6755
Mailing Address - Country:US
Mailing Address - Phone:951-929-6260
Mailing Address - Fax:
Practice Address - Street 1:12998 HESPERIA RD
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8316
Practice Address - Country:US
Practice Address - Phone:760-245-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7058225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27105ZMedicare ID - Type Unspecified