Provider Demographics
NPI:1639330616
Name:SACRAMENTO CHOICE REHABILITATION PROGRAM
Entity Type:Organization
Organization Name:SACRAMENTO CHOICE REHABILITATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRPERSON
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:OLORUNMO
Authorized Official - Last Name:ABU
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:916-425-4300
Mailing Address - Street 1:5524 ASSEMBLY COURT
Mailing Address - Street 2:STE #45
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2625
Mailing Address - Country:US
Mailing Address - Phone:916-425-4300
Mailing Address - Fax:916-391-1218
Practice Address - Street 1:5524 ASSEMBLY COURT
Practice Address - Street 2:STE #45
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2625
Practice Address - Country:US
Practice Address - Phone:916-425-4300
Practice Address - Fax:916-391-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management