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General NPI Number Information
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NPI Number | 1164880407
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Entity Type | Organization
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Legal Business Name | SOUTH PACIFIC REHABILITATION SERVICES
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 15906 PARKHOUSE DR
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City | FONTANA
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State | CA
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Zip | 92336-6501
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Country | US
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Telephone | 909-292-8467
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Fax |
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Provider Business Mailing Address
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Address Line | 15906 PARKHOUSE DR
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City | FONTANA
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State | CA
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Zip | 92336-6501
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Country | US
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Telephone | 909-292-8467
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | MRS. ANNA KATHLEEN HILLARY
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Credential |
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Telephone | 909-292-8467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | CA
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