Provider Demographics
NPI:1699830851
Name:REHABNET OUTPATIENT CENTER
Entity Type:Organization
Organization Name:REHABNET OUTPATIENT CENTER
Other - Org Name:ROC DME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DE COU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-596-9400
Mailing Address - Street 1:18368 ENTERPRISE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1201
Mailing Address - Country:US
Mailing Address - Phone:714-731-2441
Mailing Address - Fax:714-596-9500
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-451-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4968070001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4968070001Medicare NSC