=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740436096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE REHAB STAFFING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2008
-----------------------------------------------------
Last Update Date | 02/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 W ELLIOT ST APT 83
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95695-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-662-9161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 37
-----------------------------------------------------
City | ESPARTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95627-0037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-556-7292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. AARON M MIGUEL
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 909-556-7292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320700000X
-----------------------------------------------------
Taxonomy Name | Physical Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------