Healthcare Provider Details

I. General information

NPI: 1164880407
Provider Name (Legal Business Name): SOUTH PACIFIC REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15906 PARKHOUSE DR
FONTANA CA
92336-6501
US

IV. Provider business mailing address

15906 PARKHOUSE DR
FONTANA CA
92336-6501
US

V. Phone/Fax

Practice location:
  • Phone: 909-292-8467
  • Fax:
Mailing address:
  • Phone: 909-292-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ANNA KATHLEEN HILLARY
Title or Position: COTA
Credential:
Phone: 909-292-8467