Provider Demographics
NPI:1689793739
Name:SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM
Other - Org Name:SCHARP CHILD OUTPATIENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-631-8004
Mailing Address - Street 1:2610 INDUSTRY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4028
Mailing Address - Country:US
Mailing Address - Phone:310-631-8004
Mailing Address - Fax:310-631-7830
Practice Address - Street 1:2594 INDUSTRY WAY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4015
Practice Address - Country:US
Practice Address - Phone:310-667-4070
Practice Address - Fax:310-667-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7654OtherPROVIDER NUMBER