=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821304866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN CALIFORNIA REHABILITATION SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2010
-----------------------------------------------------
Last Update Date | 11/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7830 QUILL DR SUITE D
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90242-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-862-6531
-----------------------------------------------------
Fax | 562-923-5274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 SOUTH FREMONT AVE BLDG B1, SUITE B10100, BOX #99
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-587-5010
-----------------------------------------------------
Fax | 626-382-2501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. RUDY CONTRERAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-587-5010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 444863
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------