MEDICARE: FLOBAR, LLC

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	320700000X	Physical Disabilities Residential Treatment Facility	374603337	CA

General Provider Information

NPI Number	:	1811398928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOBAR, LLC

Provider Business Mailing Address
First Line	:	3532 GOVERNOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2904
Country	:	US
Telephone Number	:	858-412-6560
Fax Number	:	858-412-3520

Provider Business Practice Location Address
First Line	:	3532 GOVERNOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2904
Country	:	US
Telephone Number	:	858-412-6560
Fax Number	:	858-412-3520

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BARBARA OLEARY
Credential	:	RN
Telephone Number	:	781-964-8299

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	09/08/2014

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