Healthcare Provider Details

I. General information

NPI: 1598827495
Provider Name (Legal Business Name): INNOVATIVE SENIOR REHABILITATION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W KETTLEMAN LN
LODI CA
95242-4347
US

IV. Provider business mailing address

222 W PINE ST
LODI CA
95240-2020
US

V. Phone/Fax

Practice location:
  • Phone: 209-365-6764
  • Fax: 209-365-6764
Mailing address:
  • Phone: 209-368-1009
  • Fax: 209-368-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH JOY HADLEY
Title or Position: VP CFO
Credential:
Phone: 916-690-0757