| NPI | 1629438775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENEE MARIE TYSOL Program Manager 707-664-7798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2023-04-27 |