Provider Demographics
NPI:1922288570
Name:PACIFICCARE REHAB, INC.
Entity Type:Organization
Organization Name:PACIFICCARE REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALICIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:877-477-3422
Mailing Address - Street 1:9625 PARK ST
Mailing Address - Street 2:C
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5836
Mailing Address - Country:US
Mailing Address - Phone:877-477-3422
Mailing Address - Fax:877-477-3422
Practice Address - Street 1:9625 PARK ST
Practice Address - Street 2:C
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5836
Practice Address - Country:US
Practice Address - Phone:877-477-3422
Practice Address - Fax:877-477-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation