Healthcare Provider Details

I. General information

NPI: 1598488447
Provider Name (Legal Business Name): REHOBOTH HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 S REBER AVE
GILBERT AZ
85296-1467
US

IV. Provider business mailing address

3324 E RAY RD UNIT 517
HIGLEY AZ
85236-4525
US

V. Phone/Fax

Practice location:
  • Phone: 602-578-5445
  • Fax:
Mailing address:
  • Phone: 602-578-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLUWATOFUNMI FAKOYA
Title or Position: MANAGING PARTNER
Credential:
Phone: 602-578-5445