Basic Information
Provider Information | |||||||||
NPI: | 1437258464 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | REHABFOCUS HOME HEALTH, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FOCUS HEALTH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 120 VANTIS DR STE 200 | ||||||||
Address2: |   | ||||||||
City: | ALISO VIEJO | ||||||||
State: | CA | ||||||||
PostalCode: | 926562677 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9493491200 | ||||||||
FaxNumber: | 9493491122 | ||||||||
Practice Location | |||||||||
Address1: | 4643 QUAIL LAKES DR STE 101 | ||||||||
Address2: |   | ||||||||
City: | STOCKTON | ||||||||
State: | CA | ||||||||
PostalCode: | 952075269 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2094727005 | ||||||||
FaxNumber: | 2094729940 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/22/2006 | ||||||||
LastUpdateDate: | 03/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SPARKS | ||||||||
AuthorizedOfficialFirstName: | CAROL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
AuthorizedOfficialTelephone: | 9493491200 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 100000770 | CA | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 100000770 | 01 | CA | HOME HEALTH AGENCY LICENS | OTHER | HHA08216 | 05 | CA |   | MEDICAID |