Provider Demographics
NPI:1740219336
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:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:209-549-1000
Mailing Address - Street 1:1508 COFFEE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3181
Mailing Address - Country:US
Mailing Address - Phone:209-549-1000
Mailing Address - Fax:209-549-1016
Practice Address - Street 1:1508 COFFEE RD STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-549-1000
Practice Address - Fax:209-549-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGFC000220Medicaid
CA0246970001Medicare NSC