Basic Information
| Provider Information | |||||||||
| NPI: | 1619424553 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REHABILITATION CENTER OF ORANGE COUNTY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEALTHCARE CENTER OF ORANGE COUNTY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 W LEMON AVE | ||||||||
| Address2: | |||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910162809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266587344 | ||||||||
| FaxNumber: | 3238465788 | ||||||||
| Practice Location | |||||||||
| Address1: | 9021 KNOTT AVE | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906204138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148262330 | ||||||||
| FaxNumber: | 7149229896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ANDRADE | ||||||||
| AuthorizedOfficialFirstName: | ROCIO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CONTACT PERSON | ||||||||
| AuthorizedOfficialTelephone: | 6263460300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 060000149 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | LTC70154F | 05 | CA | MEDICAID | ZZT05674I | 05 | CA | MEDICAID |