Healthcare Provider Details

I. General information

NPI: 1083899447
Provider Name (Legal Business Name): OLYMPIC REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 N LA BREA AVE
LOS ANGELES CA
90036-2014
US

IV. Provider business mailing address

636 N LA BREA AVE
LOS ANGELES CA
90036-2014
US

V. Phone/Fax

Practice location:
  • Phone: 323-954-4000
  • Fax:
Mailing address:
  • Phone: 323-954-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: IRENE TOKAR
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 323-954-4000