Provider Demographics
NPI: | 1851636625 |
---|---|
Name: | ALLIANCE REHAB INC |
Entity Type: | Organization |
Organization Name: | ALLIANCE REHAB INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | HUNG |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NGO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 714-968-8700 |
Mailing Address - Street 1: | 9555 WARNER AVE |
Mailing Address - Street 2: | SUITE A |
Mailing Address - City: | FOUNTAIN VALLEY |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92708-2827 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-968-8700 |
Mailing Address - Fax: | 714-968-8804 |
Practice Address - Street 1: | 9555 WARNER AVE |
Practice Address - Street 2: | SUITE A |
Practice Address - City: | FOUNTAIN VALLEY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92708-2827 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-968-8700 |
Practice Address - Fax: | 714-968-8804 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-12-06 |
Last Update Date: | 2015-04-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PT26455 | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |