Provider Demographics
NPI:1659433753
Name:JEAN L. OGBURN
Entity Type:Organization
Organization Name:JEAN L. OGBURN
Other - Org Name:SIERRA REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:OGBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC,SLP
Authorized Official - Phone:209-728-0744
Mailing Address - Street 1:245 TOM BELL RD
Mailing Address - Street 2:C
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-9585
Mailing Address - Country:US
Mailing Address - Phone:209-728-0744
Mailing Address - Fax:209-728-0125
Practice Address - Street 1:245 TOM BELL RD
Practice Address - Street 2:C
Practice Address - City:MURPHYS
Practice Address - State:CA
Practice Address - Zip Code:95247-9585
Practice Address - Country:US
Practice Address - Phone:209-728-0744
Practice Address - Fax:209-728-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2494261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056847Medicare Oscar/Certification