Provider Demographics
NPI:1518980515
Name:CENTER FOR INDEPENDENT REHABILITATIVE SERVICES, INC
Entity Type:Organization
Organization Name:CENTER FOR INDEPENDENT REHABILITATIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:209-845-8231
Mailing Address - Street 1:693 HI TECH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361
Mailing Address - Country:US
Mailing Address - Phone:209-845-8231
Mailing Address - Fax:209-845-2883
Practice Address - Street 1:430 40TH STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2522
Practice Address - Country:US
Practice Address - Phone:510-653-9834
Practice Address - Fax:510-653-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000860Medicaid
CA0246970003Medicare NSC