Healthcare Provider Details

I. General information

NPI: 1346911534
Provider Name (Legal Business Name): RHAD HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9559 W PINNACLE VISTA DR
PEORIA AZ
85383-8715
US

IV. Provider business mailing address

9559 W PINNACLE VISTA DR
PEORIA AZ
85383-8715
US

V. Phone/Fax

Practice location:
  • Phone: 602-679-5050
  • Fax: 623-505-9755
Mailing address:
  • Phone: 602-679-5050
  • Fax: 623-505-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE HILLSMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 928-821-3144