Provider Demographics
NPI:1174704282
Name:BURGER REHAB
Entity type:Organization
Organization Name:BURGER REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:516-650-5064
Mailing Address - Street 1:3334 W CALDWELL AVE
Mailing Address - Street 2:APT 98
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7094
Mailing Address - Country:US
Mailing Address - Phone:516-650-5064
Mailing Address - Fax:
Practice Address - Street 1:3334 W CALDWELL AVE
Practice Address - Street 2:APT 98
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7094
Practice Address - Country:US
Practice Address - Phone:516-650-5064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16477314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility