Provider Demographics
NPI:1841640083
Name:SOUTH PACIFIC REHAB SERVICES
Entity type:Organization
Organization Name:SOUTH PACIFIC REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROWINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIBEDLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-986-1977
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:SUITE 60
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE 60
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-986-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-19
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7797314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225100000Medicaid