Healthcare Provider Details

I. General information

NPI: 1417978305
Provider Name (Legal Business Name): REHOBOTH, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 N 2ND ST
DARDANELLE AR
72834-2601
US

IV. Provider business mailing address

900 W 12TH ST
RUSSELLVILLE AR
72801-6606
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-5858
  • Fax: 479-890-6013
Mailing address:
  • Phone: 479-968-5858
  • Fax: 479-890-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number353
License Number StateAR

VIII. Authorized Official

Name: REBECCA BRASHEAR
Title or Position: OWNER
Credential:
Phone: 479-968-5858