Provider Demographics
NPI:1245718287
Name:RAPHA REHABILITIES
Entity type:Organization
Organization Name:RAPHA REHABILITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:443-992-3236
Mailing Address - Street 1:4959 PALO VERDE ST STE 109C
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2358
Mailing Address - Country:US
Mailing Address - Phone:909-971-3092
Mailing Address - Fax:310-861-1617
Practice Address - Street 1:4959 PALO VERDE ST STE 110B
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2303
Practice Address - Country:US
Practice Address - Phone:909-971-3092
Practice Address - Fax:310-861-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities