Provider Demographics
NPI:1720014210
Name:CENTER FOR INDEPENDENT REHABILITATIVE SERVICES INC
Entity Type:Organization
Organization Name:CENTER FOR INDEPENDENT REHABILITATIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-845-8231
Mailing Address - Street 1:693 HI TECH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361
Mailing Address - Country:US
Mailing Address - Phone:209-845-8231
Mailing Address - Fax:209-845-2883
Practice Address - Street 1:693 HI TECH PARKWAY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361
Practice Address - Country:US
Practice Address - Phone:209-845-8231
Practice Address - Fax:209-845-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000861Medicaid
CAGXC000861Medicaid