Provider Demographics
NPI:1558513010
Name:CALIFORNIA AQUATIC THERAPY & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:CALIFORNIA AQUATIC THERAPY & WELLNESS CENTER, INC.
Other - Org Name:POOLS OF HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-293-7335
Mailing Address - Street 1:6801 LONG BEACH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805
Mailing Address - Country:US
Mailing Address - Phone:310-537-2224
Mailing Address - Fax:310-537-2255
Practice Address - Street 1:6801 LONG BEACH BOULEVARD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:310-537-2224
Practice Address - Fax:310-537-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6921174400000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty