Provider Demographics
NPI:1285135301
Name:COMPLEX REHAB SPECIALIST
Entity type:Organization
Organization Name:COMPLEX REHAB SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-597-0609
Mailing Address - Street 1:1215 W IMPERIAL HWY STE 101B
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3738
Mailing Address - Country:US
Mailing Address - Phone:866-597-0609
Mailing Address - Fax:866-597-0609
Practice Address - Street 1:251 IMPERIAL HWY STE 470
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1063
Practice Address - Country:US
Practice Address - Phone:866-597-0609
Practice Address - Fax:866-597-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAATP1528332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASRRC103216572OtherRESALE CERTIFICATE