=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891038881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STROKE RECOVERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2013
-----------------------------------------------------
Last Update Date | 01/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 E ALEJO RD
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92262-6253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-323-7676
-----------------------------------------------------
Fax | 760-325-8026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 E ALEJO RD
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92262-6253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-323-7676
-----------------------------------------------------
Fax | 760-325-8026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. JAY SELLER
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 760-323-7676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------