Basic Information
| Provider Information | |||||||||
| NPI: | 1245403906 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANDS ON HANDS REHABILITATION CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 ADAMS AVENUE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926264865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145562288 | ||||||||
| FaxNumber: | 7144351745 | ||||||||
| Practice Location | |||||||||
| Address1: | 16152 BEACH BLVD | ||||||||
| Address2: | SUITE 285 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926473806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148426202 | ||||||||
| FaxNumber: | 7148426762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROYAL | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7145562288 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | AA357228 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | ZZZ64332Z | 01 | CA | BLUE SHIELD | OTHER |