Basic Information
| Provider Information | |||||||||
| NPI: | 1851533475 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE SENIOR CARE REHABILITATION AGENCY OF LOS ANGELES LLC | ||||||||
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| OtherOrganizationName: | INNOVATIVE SENIOR CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 WESTWOOD PL | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152212250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 921 E MAIN ST | ||||||||
| Address2: | STE B | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930013077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155648034 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 03/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | MCGLASSON | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. DIRECTOR REGULATORY PRACTICES | ||||||||
| AuthorizedOfficialTelephone: | 6155648034 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.