Basic Information
| Provider Information | |||||||||
| NPI: | 1134585151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16260 VENTURA BLVD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189861977 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17922 SAN FERNANDO MISSION BLVD | ||||||||
| Address2: | |||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913444043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183601864 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2016 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8189861977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | SP5019 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric |
No ID Information.