Healthcare Provider Details

I. General information

NPI: 1205193901
Provider Name (Legal Business Name): ALTHEA REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3397 S CAROL DR
FLAGSTAFF AZ
86001-9010
US

IV. Provider business mailing address

3397 S CAROL DR
FLAGSTAFF AZ
86001-9010
US

V. Phone/Fax

Practice location:
  • Phone: 928-853-5906
  • Fax:
Mailing address:
  • Phone: 928-853-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3329
License Number StateAZ

VIII. Authorized Official

Name: DAN LOERA
Title or Position: REHAB MANAGER
Credential: OCCUPATIONAL THERAIS
Phone: 928-853-5906