Provider Demographics
NPI:1629222856
Name:SANTA TERESITA REHABILITATION AGENCY
Entity Type:Organization
Organization Name:SANTA TERESITA REHABILITATION AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MADONNA JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-359-3243
Mailing Address - Street 1:819 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1703
Mailing Address - Country:US
Mailing Address - Phone:626-932-3439
Mailing Address - Fax:626-358-5083
Practice Address - Street 1:819 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1703
Practice Address - Country:US
Practice Address - Phone:626-932-3439
Practice Address - Fax:626-358-5083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA TERESITA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation