Healthcare Provider Details

I. General information

NPI: 1497032247
Provider Name (Legal Business Name): REHAB WITHOUT WALLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 N DREAMY DRAW DR STE 120
PHOENIX AZ
85020-4641
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-5186
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-7470
  • Fax:
Mailing address:
  • Phone: 502-394-2100
  • Fax: 502-394-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGIE MATTINGLY
Title or Position: MANAGER-PROVIDER ENROLLMENT
Credential:
Phone: 502-630-7147