Provider Demographics
NPI:1841679131
Name:TAVARUA REHABILITATION SERVICES
Entity type:Organization
Organization Name:TAVARUA REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRAMESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-313-5503
Mailing Address - Street 1:474 S CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-4733
Mailing Address - Country:US
Mailing Address - Phone:626-858-9500
Mailing Address - Fax:626-858-9090
Practice Address - Street 1:474 S CITRUS AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-4733
Practice Address - Country:US
Practice Address - Phone:626-858-9500
Practice Address - Fax:626-858-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW4776101YA0400X
261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty