Healthcare Provider Details

I. General information

NPI: 1891148201
Provider Name (Legal Business Name): SOUTH PACIFIC REHABILITATION SERVISEC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10469 LARWIN AVE UNIT 4
CHATSWORTH CA
91311-0314
US

IV. Provider business mailing address

10469 LARWIN AVE 4
CHATSWORTH CA
91311
US

V. Phone/Fax

Practice location:
  • Phone: 818-274-7478
  • Fax:
Mailing address:
  • Phone: 818-274-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number224200000
License Number StateCA

VIII. Authorized Official

Name: TERESA FERN FARAG
Title or Position: OTA/L
Credential: AA DEGREE
Phone: 818-274-7478