Healthcare Provider Details

I. General information

NPI: 1699780064
Provider Name (Legal Business Name): SOUTH PASADENA REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 MISSION ST
SOUTH PASADENA CA
91030-3144
US

IV. Provider business mailing address

904 MISSION ST
SOUTH PASADENA CA
91030-3144
US

V. Phone/Fax

Practice location:
  • Phone: 626-799-9571
  • Fax: 626-799-2734
Mailing address:
  • Phone: 626-799-9571
  • Fax: 626-799-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000038
License Number StateCA

VIII. Authorized Official

Name: MR. GUY REGGEV
Title or Position: MEMBER
Credential:
Phone: 626-799-9571