Provider Demographics
NPI:1639323520
Name:SOUTH COAST REHABILITATION CENTER
Entity Type:Organization
Organization Name:SOUTH COAST REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-549-6500
Mailing Address - Street 1:1650 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4958
Mailing Address - Country:US
Mailing Address - Phone:714-549-6500
Mailing Address - Fax:
Practice Address - Street 1:1650 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4958
Practice Address - Country:US
Practice Address - Phone:714-549-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRIFFIN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty