Provider Demographics
NPI:1962548875
Name:CENTRE FOR NEURO SKILLS - L.A.
Entity type:Organization
Organization Name:CENTRE FOR NEURO SKILLS - L.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:661-872-3408
Mailing Address - Street 1:5215 ASHE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-2069
Mailing Address - Country:US
Mailing Address - Phone:661-872-3408
Mailing Address - Fax:661-872-5150
Practice Address - Street 1:16542 VENTURA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4510
Practice Address - Country:US
Practice Address - Phone:818-783-3800
Practice Address - Fax:818-873-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9601311261QR0400X
CA960001311320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9601311OtherDEPT OF HEALTH SERVICES