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NPI Code Detail

MEDICARE: SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM

MEDICARE: SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17242OTHERCAPROVIDER NUMBER

General Provider Information

NPI Number : 1861521841
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM
Provider Business Mailing Address
First Line : 2610 INDUSTRY WAY
Second Line : SUITE A
City : LYNWOOD
State : CA
Zip : 90262-4028
Country : US
Telephone Number : 310-631-8004
Fax Number : 310-631-7830
Provider Business Practice Location Address
First Line : 8836 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-4832
Country : US
Telephone Number : 213-451-4370
Fax Number : 323-458-8744
Authorized Official
Title or Position : CEO/PRESIDENT
Name : JACK M BARBOUR
Credential : M.D.
Telephone Number : 310-631-8004
Provider Enumeration Date : 03/05/2007
Last Update Date : 06/02/2021

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Directions to “SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM ” Practice Location

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