Provider Demographics
NPI:1306960851
Name:INTERFACE REHAB, INC.
Entity type:Organization
Organization Name:INTERFACE REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANANT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MED
Authorized Official - Phone:714-646-8300
Mailing Address - Street 1:740 S PLACENTIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6832
Mailing Address - Country:US
Mailing Address - Phone:714-646-8300
Mailing Address - Fax:714-646-8321
Practice Address - Street 1:740 S PLACENTIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6832
Practice Address - Country:US
Practice Address - Phone:714-646-8300
Practice Address - Fax:714-646-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities