Provider Demographics
NPI:1427016740
Name:CHICO REHABILITATION HOSPITAL, LLC
Entity type:Organization
Organization Name:CHICO REHABILITATION HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:GORMLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-907-7677
Mailing Address - Street 1:2850 SIERRA SUNRISE TER
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8401
Mailing Address - Country:US
Mailing Address - Phone:530-894-1010
Mailing Address - Fax:
Practice Address - Street 1:2850 SIERRA SUNRISE TER
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8401
Practice Address - Country:US
Practice Address - Phone:530-894-1010
Practice Address - Fax:530-894-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555625Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER