Healthcare Provider Details

I. General information

NPI: 1750356523
Provider Name (Legal Business Name): ACADIA REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13260 N 94TH DR STE 205
PEORIA AZ
85381-4240
US

IV. Provider business mailing address

13260 N 94TH DR STE 205
PEORIA AZ
85381-4240
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-6573
  • Fax: 623-583-6571
Mailing address:
  • Phone: 623-583-6573
  • Fax: 623-583-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTC3883
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License NumberOTC3883
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberOTC3883
License Number StateAZ

VIII. Authorized Official

Name: DR. WILLIAM HAAS
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 623-583-6573