Healthcare Provider Details

I. General information

NPI: 1962360644
Provider Name (Legal Business Name): REBOUND REBRAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6158 DOLORES AVE
ANDERSON CA
96007-4807
US

IV. Provider business mailing address

6158 DOLORES AVE
ANDERSON CA
96007-4807
US

V. Phone/Fax

Practice location:
  • Phone: 530-591-9596
  • Fax:
Mailing address:
  • Phone: 530-591-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICE SARAH KING
Title or Position: CHIEF OF BOARD
Credential: BA, SUDRC
Phone: 530-591-9596