Provider Demographics
NPI:1215940606
Name:CARE CENTER REHABILITATION AND PAIN MANAGEMENT
Entity type:Organization
Organization Name:CARE CENTER REHABILITATION AND PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, PHD
Authorized Official - Phone:818-784-0990
Mailing Address - Street 1:16550 VENTURA BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2004
Mailing Address - Country:US
Mailing Address - Phone:818-784-0990
Mailing Address - Fax:818-784-9069
Practice Address - Street 1:16550 VENTURA BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2004
Practice Address - Country:US
Practice Address - Phone:818-784-0990
Practice Address - Fax:818-784-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14180103TC0700X
CAMFC21561106H00000X
CA23728111NX0800X
CAAC4054171100000X
CAG36778204C00000X
CAC26209207RA0401X
CAA418712081P2900X
CAG36778A2081S0010X
CAFUNCTIONAL RESTORATI261QM1300X
CAPT22297261QP2000X
CA261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Not Answered207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Not Answered2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G367780OtherBLUE CROSS
CA2000097200OtherC1 DEPT OF LABOR
CAZZZ379432ZOtherBLUE SHIELD
CAZZZ379432ZOtherBLUE SHIELD