Provider Demographics
NPI:1356109987
Name:REBOUND SUPPORT GROUP LLC
Entity type:Organization
Organization Name:REBOUND SUPPORT GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:JEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-232-0649
Mailing Address - Street 1:515 W COMMONWEALTH AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1752
Mailing Address - Country:US
Mailing Address - Phone:714-232-0649
Mailing Address - Fax:
Practice Address - Street 1:515 W COMMONWEALTH AVE STE 213
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1752
Practice Address - Country:US
Practice Address - Phone:714-232-0649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder