Provider Demographics
NPI:1053178244
Name:INTERFACE REHAB, INC.
Entity type:Organization
Organization Name:INTERFACE REHAB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MIS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-646-8308
Mailing Address - Street 1:774 S PLACENTIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6838
Mailing Address - Country:US
Mailing Address - Phone:714-646-8300
Mailing Address - Fax:714-646-8183
Practice Address - Street 1:1801 BOXHEART DR
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3269
Practice Address - Country:US
Practice Address - Phone:707-756-5039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERFACE REHAB, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility