Healthcare Provider Details

I. General information

NPI: 1619424553
Provider Name (Legal Business Name): REHABILITATION CENTER OF ORANGE COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 KNOTT AVE
BUENA PARK CA
90620-4138
US

IV. Provider business mailing address

107 W LEMON AVE
MONROVIA CA
91016-2809
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-2330
  • Fax: 714-922-9896
Mailing address:
  • Phone: 626-658-7344
  • Fax: 323-846-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060000149
License Number StateCA

VIII. Authorized Official

Name: ROCIO ANDRADE
Title or Position: CONTACT PERSON
Credential:
Phone: 626-346-0300