Healthcare Provider Details

I. General information

NPI: 1548776172
Provider Name (Legal Business Name): BELLAIRE HEALTH & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 AVENUE OF THE STARS STE 200
CENTURY CITY CA
90067-6015
US

IV. Provider business mailing address

1901 AVENUE OF THE STARS STE 200
CENTURY CITY CA
90067-6015
US

V. Phone/Fax

Practice location:
  • Phone: 310-395-4730
  • Fax: 909-306-7185
Mailing address:
  • Phone: 310-395-4730
  • Fax: 909-306-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name: KENYATTA HARRIS
Title or Position: CEO
Credential:
Phone: 818-223-7520