Provider Demographics
NPI:1538174990
Name:POINT LOMA REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:POINT LOMA REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-800-1191
Mailing Address - Street 1:3202 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5401
Mailing Address - Country:US
Mailing Address - Phone:619-224-4141
Mailing Address - Fax:619-224-1309
Practice Address - Street 1:3202 DUKE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-224-4141
Practice Address - Fax:619-224-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000088314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05322HMedicaid
CAZZT05322IMedicaid
CAZZT05322HMedicaid
CAZZT05322HMedicaid