Provider Demographics
NPI:1043317324
Name:MOUNTAIN VIEW REHABILITATION MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:MOUNTAIN VIEW REHABILITATION MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-477-6283
Mailing Address - Street 1:10556 COMBIE RD
Mailing Address - Street 2:#6439
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8908
Mailing Address - Country:US
Mailing Address - Phone:530-268-4664
Mailing Address - Fax:530-268-4666
Practice Address - Street 1:380 SIERRA COLLEGE DR
Practice Address - Street 2:STE 200
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5081
Practice Address - Country:US
Practice Address - Phone:530-477-0893
Practice Address - Fax:530-477-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07115ZOtherBLUE SHIELD GROUP
CADA2353OtherMEDICARE RR GROUP
CA=========OtherBLUE CROSS GROUP
CAZZZ26090ZMedicare ID - Type UnspecifiedMEDICARE GROUP