Provider Demographics
NPI:1154788628
Name:INTERFACE REHABILITATION
Entity type:Organization
Organization Name:INTERFACE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:800-870-7989
Mailing Address - Street 1:774 S PLACENTIA AVE
Mailing Address - Street 2:PLACENTIA
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6832
Mailing Address - Country:US
Mailing Address - Phone:800-870-7989
Mailing Address - Fax:
Practice Address - Street 1:774 S PLACENTIA AVE
Practice Address - Street 2:PLACENTIA
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6832
Practice Address - Country:US
Practice Address - Phone:800-870-7989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5670283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital