Provider Demographics
NPI:1851508659
Name:ADVANCED RECOVERY REHABILITATION CENTER
Entity Type:Organization
Organization Name:ADVANCED RECOVERY REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-386-1231
Mailing Address - Street 1:4419 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2910
Mailing Address - Country:US
Mailing Address - Phone:818-386-1231
Mailing Address - Fax:818-386-0483
Practice Address - Street 1:4419 VAN NUYS BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2910
Practice Address - Country:US
Practice Address - Phone:818-386-1231
Practice Address - Fax:818-386-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation