Provider Demographics
NPI:1881749323
Name:MANAGED CARE REHAB., INC.
Entity type:Organization
Organization Name:MANAGED CARE REHAB., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KAYHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOODJANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-886-2245
Mailing Address - Street 1:18531 ROSCOE BLVD
Mailing Address - Street 2:SUITE 215A
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5462
Mailing Address - Country:US
Mailing Address - Phone:818-886-2245
Mailing Address - Fax:818-886-3826
Practice Address - Street 1:18531 ROSCOE BLVD
Practice Address - Street 2:SUITE 215A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5462
Practice Address - Country:US
Practice Address - Phone:818-886-2245
Practice Address - Fax:818-886-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0203060Medicaid
CAPT0203060Medicaid