Provider Demographics
NPI:1144460577
Name:REHABNET OUTPATIENT CENTER
Entity type:Organization
Organization Name:REHABNET OUTPATIENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-451-2292
Mailing Address - Street 1:5966 JAMIESON AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1018
Mailing Address - Country:US
Mailing Address - Phone:818-344-6433
Mailing Address - Fax:
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-651-2292
Practice Address - Fax:310-451-2554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHABNET OUTPATIENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6103261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation