Healthcare Provider Details

I. General information

NPI: 1841640083
Provider Name (Legal Business Name): SOUTH PACIFIC REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 06/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD SUITE 60
ENCINO CA
91436-2203
US

IV. Provider business mailing address

16260 VENTURA BLVD SUITE 60
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7797
License Number StateCA

VIII. Authorized Official

Name: MRS. ROWINA ORIBEDLLO
Title or Position: HUMAN RESOURCES MANAGER
Credential:
Phone: 818-986-1977