Provider Demographics
NPI:1801924238
Name:OLYMPIC REHABILITATION CENTER, INC
Entity type:Organization
Organization Name:OLYMPIC REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIRULSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-954-4000
Mailing Address - Street 1:624 N LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2014
Mailing Address - Country:US
Mailing Address - Phone:323-954-4000
Mailing Address - Fax:
Practice Address - Street 1:624 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2014
Practice Address - Country:US
Practice Address - Phone:323-954-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU40708FMedicaid
CAADU70362FMedicaid
CAADU70136FMedicaid