Healthcare Provider Details

I. General information

NPI: 1366446916
Provider Name (Legal Business Name): NOVACARE OUTPATIENT REHABILITATION OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N DUTTON AVE STE G
SANTA ROSA CA
95401-4638
US

IV. Provider business mailing address

1090 SUNRISE AVE STE 140
ROSEVILLE CA
95661-4466
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-1411
  • Fax:
Mailing address:
  • Phone: 916-782-1212
  • Fax: 916-773-1481

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. DAVID SMITH
Title or Position: CEO
Credential:
Phone: 916-782-1212