Provider Demographics
NPI:1053024380
Name:RESILIENT REHABILITATION, LLC
Entity type:Organization
Organization Name:RESILIENT REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:805-415-1536
Mailing Address - Street 1:4929 MEDINA DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4324
Mailing Address - Country:US
Mailing Address - Phone:818-918-2222
Mailing Address - Fax:
Practice Address - Street 1:4929 MEDINA DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4324
Practice Address - Country:US
Practice Address - Phone:818-918-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder