Provider Demographics
NPI:1942585153
Name:SANTA CRUZ CORE FITNESS AND REHAB
Entity type:Organization
Organization Name:SANTA CRUZ CORE FITNESS AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-425-9500
Mailing Address - Street 1:317 POTRERO ST
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-7610
Mailing Address - Country:US
Mailing Address - Phone:831-425-9500
Mailing Address - Fax:831-466-9156
Practice Address - Street 1:317 POTRERO ST
Practice Address - Street 2:STE C
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-7610
Practice Address - Country:US
Practice Address - Phone:831-425-9500
Practice Address - Fax:831-466-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)