Healthcare Provider Details

I. General information

NPI: 1487046900
Provider Name (Legal Business Name): HALLMARK REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 TERMINO AVE #2402
LONG BEACH CA
90815-2691
US

IV. Provider business mailing address

1803 TERMINO AVE #2402
LONG BEACH CA
90815-2691
US

V. Phone/Fax

Practice location:
  • Phone: 973-738-2585
  • Fax:
Mailing address:
  • Phone: 973-738-2585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7757
License Number StateCA

VIII. Authorized Official

Name: MS. SHARLEEN ENGEL
Title or Position: OTR/L
Credential:
Phone: 973-738-2585