| NPI | 1720085343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK LYMAN RUSSELL Administrator 209-369-6996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: CA 030000781) |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2020-08-22 |