Healthcare Provider Details

I. General information

NPI: 1861205130
Provider Name (Legal Business Name): AM REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10437 SUNNYBRAE AVE
CHATSWORTH CA
91311-2462
US

IV. Provider business mailing address

245 MAIN ST APT 109
VENICE CA
90291-5215
US

V. Phone/Fax

Practice location:
  • Phone: 626-379-4860
  • Fax:
Mailing address:
  • Phone: 626-379-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN AUSTIN
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 818-915-5668