Provider Demographics
NPI:1669037362
Name:MEDREV
Entity Type:Organization
Organization Name:MEDREV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-772-9355
Mailing Address - Street 1:558 CHELSEA WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5880
Mailing Address - Country:US
Mailing Address - Phone:951-772-9355
Mailing Address - Fax:
Practice Address - Street 1:558 CHELSEA WAY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5880
Practice Address - Country:US
Practice Address - Phone:951-772-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization