Healthcare Provider Details

I. General information

NPI: 1851359145
Provider Name (Legal Business Name): REHAB ARIZONA NEURO REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 S ELLSWORTH RD STE 111
MESA AZ
85212-2144
US

IV. Provider business mailing address

2725 WATER RIDGE PKWY STE 300
CHARLOTTE NC
28217-4580
US

V. Phone/Fax

Practice location:
  • Phone: 866-817-1788
  • Fax:
Mailing address:
  • Phone: 704-831-5050
  • Fax: 704-831-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN DEAN CAMPBELL
Title or Position: PRESIDENT
Credential:
Phone: 704-831-5050