Provider Demographics
NPI:1306051891
Name:FUNCTION JUNCTION REHABILITATION CENTER
Entity type:Organization
Organization Name:FUNCTION JUNCTION REHABILITATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OTC
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-465-4003
Mailing Address - Street 1:555 SOUTH HIGHWAY 101
Mailing Address - Street 2:B
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531
Mailing Address - Country:US
Mailing Address - Phone:707-465-4003
Mailing Address - Fax:
Practice Address - Street 1:555 SOUTH HIGHWAY 101
Practice Address - Street 2:B
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531
Practice Address - Country:US
Practice Address - Phone:707-465-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAA549790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4356490001Medicare NSC
CAZZZ00849ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER