Basic Information
| Provider Information | |||||||||
| NPI: | 1841640083 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH PACIFIC REHAB SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16260 VENTURA BLVD | ||||||||
| Address2: | SUITE 60 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362203 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 16260 VENTURA BLVD | ||||||||
| Address2: | SUITE 60 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189861977 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2016 | ||||||||
| LastUpdateDate: | 06/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | ORIBEDLLO | ||||||||
| AuthorizedOfficialFirstName: | ROWINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8189861977 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 7797 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 225100000 | 05 | CA | MEDICAID |