Provider Demographics
NPI:1689812174
Name:BIG FUN THERAPY AND RECREATIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:BIG FUN THERAPY AND RECREATIONAL SERVICES, LLC
Other - Org Name:BIG FUN THERAPY AND RECREATIONAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HURWIN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:310-837-7849
Mailing Address - Street 1:3710 S S ROBERTSON BLVD.
Mailing Address - Street 2:#225
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2350
Mailing Address - Country:US
Mailing Address - Phone:310-837-7849
Mailing Address - Fax:310-838-8454
Practice Address - Street 1:3710 S S ROBERTSON BLVD.
Practice Address - Street 2:#225
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2350
Practice Address - Country:US
Practice Address - Phone:310-837-7849
Practice Address - Fax:310-838-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty