Healthcare Provider Details

I. General information

NPI: 1972686863
Provider Name (Legal Business Name): CASA COLINA COMPREHENSIVE OUTPATIENT REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E BONITA AVENUE
POMONA CA
91767
US

IV. Provider business mailing address

PO BOX 6001
POMONA CA
91769-6001
US

V. Phone/Fax

Practice location:
  • Phone: 909-596-7733
  • Fax: 909-596-4943
Mailing address:
  • Phone: 909-596-7733
  • Fax: 909-593-9417

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: MR. FELICE LOVERSO
Title or Position: PRESIDENT & CEO
Credential: PHD
Phone: 909-596-7733