Provider Demographics
NPI:1194956433
Name:MADERA REHABILITATION CENTER, INC
Entity type:Organization
Organization Name:MADERA REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-222-4060
Mailing Address - Street 1:4545 N WEST AVE
Mailing Address - Street 2:STE 118A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0946
Mailing Address - Country:US
Mailing Address - Phone:559-222-4060
Mailing Address - Fax:559-222-4260
Practice Address - Street 1:2000 N SCHNOOR ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5050
Practice Address - Country:US
Practice Address - Phone:559-222-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy