Provider Demographics
NPI:1861443434
Name:WASHINGTON OUTPATIENT REHABILITATION CENTER, A JOINT VENTURE
Entity Type:Organization
Organization Name:WASHINGTON OUTPATIENT REHABILITATION CENTER, A JOINT VENTURE
Other - Org Name:WASHINGTON OUTPATIENT REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-745-6500
Mailing Address - Street 1:39141 CIVIC CENTER DRIVE
Mailing Address - Street 2:120
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5831
Mailing Address - Country:US
Mailing Address - Phone:510-794-9672
Mailing Address - Fax:510-792-8138
Practice Address - Street 1:39141 CIVIC CENTER DRIVE
Practice Address - Street 2:120
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5831
Practice Address - Country:US
Practice Address - Phone:510-794-9672
Practice Address - Fax:510-792-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ34510ZOtherBLUE SHIELD OF CALIFORNIA
CAGPT001080Medicaid
CAZZZ02534ZMedicare PIN