Provider Demographics
NPI:1508004979
Name:CASA COLINA CENTERS FOR REHABILITATION, INC.
Entity Type:Organization
Organization Name:CASA COLINA CENTERS FOR REHABILITATION, INC.
Other - Org Name:CASA COLINA HOME & COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-596-7733
Mailing Address - Street 1:255 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1923
Mailing Address - Country:US
Mailing Address - Phone:909-596-7733
Mailing Address - Fax:909-593-7541
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:909-593-7541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA COLINA CENTERS FOR REHABILITATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191593695320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities