Provider Demographics
NPI:1487694287
Name:ANBERRY PHYSICAL REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:ANBERRY PHYSICAL REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:GORMLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:714-841-3700
Mailing Address - Street 1:17011 BEACH BLVD.
Mailing Address - Street 2:SUITE 1130
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7402
Mailing Address - Country:US
Mailing Address - Phone:714-841-2083
Mailing Address - Fax:866-837-4458
Practice Address - Street 1:1675 SHAFFER ROSD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4456
Practice Address - Country:US
Practice Address - Phone:209-841-2083
Practice Address - Fax:209-357-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
CAZZZ32050Z261QP2000X, 261QX0200X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32050ZMedicare PIN