Healthcare Provider Details

I. General information

NPI: 1194956433
Provider Name (Legal Business Name): MADERA REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N SCHNOOR ST SUITE 102
MADERA CA
93637-5050
US

IV. Provider business mailing address

4545 N WEST AVE STE 118A
FRESNO CA
93705-0946
US

V. Phone/Fax

Practice location:
  • Phone: 559-222-4060
  • Fax:
Mailing address:
  • Phone: 559-222-4060
  • Fax: 559-222-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN CRIST
Title or Position: OWNER
Credential: R.N.
Phone: 559-222-4060