MEDICARE: LAUREL GROVE HOSPITAL-REHAB UNIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273Y00000X	Rehabilitation Hospital Unit	140000030	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447297171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL GROVE HOSPITAL-REHAB UNIT

Provider Business Mailing Address
First Line	:	PO BOX 748373
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-8373
Country	:	US
Telephone Number	:	855-398-1633
Fax Number	:	510-869-6592

Provider Business Practice Location Address
First Line	:	19933 LAKE CHABOT RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4003
Country	:	US
Telephone Number	:	510-582-1730
Fax Number	:

Authorized Official
Title or Position	:	VP SHARED SERVICES
Name	:	MR. BRIAN TRENT HUNTER
Credential	:
Telephone Number	:	916-297-8555

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	12/03/2013

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