Western Pacific Re-Hab

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

19-123 Issued in CA

Legal business name

WESTERN PACIFIC RE-HAB

Practice address

7232 Canby Ave
Suites 4,5,6
Reseda, CA 91335-3006

Phone

(818) 705-5561

NPI assigned

Jun 24, 2013

Last updated

Jan 23, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Hickman

Title

Ceo

Phone

(818) 956-3737

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Western Pacific Re-Hab

  • Methadone Clinic
  • Norwalk, CA
  • NPI 1205275195

  O20200415001392

  Same enrollment
• Western Pacific Re-Hab

  • Methadone Clinic
  • Costa Mesa, CA
  • NPI 1578902466

  O20200415001392

  Same enrollment
• Western Pacific Re-Hab

  • Methadone Clinic
  • Glendale, CA
  • NPI 1770922650

  O20200415001392

  Same enrollment
• Western Pacific Re-Hab

  • Methadone Clinic
  • Lancaster, CA
  • NPI 1871932764

  O20200415001392

  Same enrollment
• Western Pacific Re-Hab

  • Methadone Clinic
  • Panorama City, CA
  • NPI 1881033777

  O20200415001392

  Same enrollment
• Western Pacific Re-Hab

  • Methadone Clinic
  • Fullerton, CA
  • NPI 1922447812

  O20200415001392

  Same enrollment

Tax ID family

Western Pacific Re-Hab7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

• Western Pacific Re-Hab

  • Methadone Clinic
  • Norwalk, CA
  • NPI 1205275195
  NPD tax ID
• Western Pacific Re-Hab

  • Methadone Clinic
  • Costa Mesa, CA
  • NPI 1578902466
  NPD tax ID
• Western Pacific Re-Hab

  • Methadone Clinic
  • Glendale, CA
  • NPI 1770922650
  NPD tax ID
• Western Pacific Re-Hab

  • Methadone Clinic
  • Lancaster, CA
  • NPI 1871932764
  NPD tax ID
• Western Pacific Re-Hab

  • Methadone Clinic
  • Panorama City, CA
  • NPI 1881033777
  NPD tax ID
• Western Pacific Re-Hab

  • Methadone Clinic
  • Fullerton, CA
  • NPI 1922447812
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eulalia Miranda Reyes

  • Addiction (Substance Use Disorder) Counselor
  • Reseda, CA
  • NPI 1235613852
  NPD (past)
• Deanna Marie Rinehart

  • Addiction (Substance Use Disorder) Counselor
  • Los Angeles, CA
  • NPI 1770073793
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1437598323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4544 SAN FERNANDO RD",
            "address_2": "SUITE 202",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041987",
            "telephone_number": "818-956-3737",
            "fax_number": "818-543-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7232 CANBY AVE",
            "address_2": "SUITES 4,5,6",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913353006",
            "telephone_number": "818-705-5561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN PACIFIC RE-HAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-24",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-956-3737"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CA",
            "license": "19-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DRUG MEDI-CAL",
            "identifier": "1948",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mandana Ighani Werner, L.C.S.W
• Liz West
• Nadine West
• Western Dental Services, Inc.
• Western Pacific Med-Corp
• White Rose Home Health, Inc.
• Jody Wicks, D.D.S.
• Wilbur Sleep Center
• Wilbur Sleeping Center Inc
• William Roberts Marriage & Family Therapist, Professional Corporation

• Methadone Clinic in Reseda, CA
• Providers in Reseda, CA by specialty
• Methadone Clinic in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.