Provider Demographics
NPI:1710977780
Name:THE REHABILITATION CENTRE OF BEVERLY HILLS
Entity Type:Organization
Organization Name:THE REHABILITATION CENTRE OF BEVERLY HILLS
Other - Org Name:THE REHABILITATION CENTRE OF BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-782-1500
Mailing Address - Street 1:580 S SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4621
Mailing Address - Country:US
Mailing Address - Phone:323-782-1500
Mailing Address - Fax:323-782-1510
Practice Address - Street 1:580 S SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4621
Practice Address - Country:US
Practice Address - Phone:323-782-1500
Practice Address - Fax:323-782-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000142314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710977780Medicaid
CA555700Medicare Oscar/Certification