Basic Information
| Provider Information | |||||||||
| NPI: | 1417372111 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIVIDAD MEDICAL CENTER REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 80007 | ||||||||
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| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939123195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317554111 | ||||||||
| FaxNumber: | 8317554087 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317554242 | ||||||||
| FaxNumber: | 8317554087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2014 | ||||||||
| LastUpdateDate: | 03/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | WEIS | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8317554185 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | CA | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 1699979245 | 05 | CA | MEDICAID | 1174727143 | 05 | CA | MEDICAID |