Provider Demographics
NPI:1861406100
Name:FARWEST REHABILITATION, INC
Entity type:Organization
Organization Name:FARWEST REHABILITATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-247-1280
Mailing Address - Street 1:1225 EUREKA WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-247-1280
Mailing Address - Fax:530-247-0310
Practice Address - Street 1:1225 EUREKA WY
Practice Address - Street 2:B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-247-1280
Practice Address - Fax:530-247-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21096ZMedicare PIN