MEDICARE: REBIRTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103TP2701X	Group Psychotherapy Psychologist
3	106S00000X	Behavior Technician
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1518644814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBIRTH CENTER

Provider Business Mailing Address
First Line	:	9023 W HUBBELL ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3882
Country	:	US
Telephone Number	:	602-731-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	5008 W GLENDALE AVE STE 110
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2751
Country	:	US
Telephone Number	:	602-731-5188
Fax Number	:

Authorized Official
Title or Position	:	ADM
Name	:	LESLIE JONES
Credential	:	BHT
Telephone Number	:	602-731-5188

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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Directions to “REBIRTH CENTER ” Practice Location

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