Healthcare Provider Details

I. General information

NPI: 1275656951
Provider Name (Legal Business Name): ANBERRY PHYSICAL REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SHAFFER RD
ATWATER CA
95301-4456
US

IV. Provider business mailing address

1685 SHAFFER RD
ATWATER CA
95301-4456
US

V. Phone/Fax

Practice location:
  • Phone: 209-357-3420
  • Fax: 209-357-0904
Mailing address:
  • Phone: 209-357-3420
  • Fax: 209-357-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number040000070
License Number StateCA

VIII. Authorized Official

Name: DAVE KUHLS
Title or Position: ADMINISTRATRO
Credential:
Phone: 209-357-3420