Healthcare Provider Details

I. General information

NPI: 1134201999
Provider Name (Legal Business Name): REM MEDICAL ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 E BROADWAY RD SUITE 110
MESA AZ
85206-1732
US

IV. Provider business mailing address

300 ROSEWOOD DR SUITE 104
DANVERS MA
01923-1384
US

V. Phone/Fax

Practice location:
  • Phone: 480-218-6222
  • Fax: 480-218-6549
Mailing address:
  • Phone: 978-774-7243
  • Fax: 978-774-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. PAUL S. VALENTINE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 617-783-1441