Healthcare Provider Details

I. General information

NPI: 1346394293
Provider Name (Legal Business Name): REM MEDICAL WEST PHOENIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD SUITE 305
PHOENIX AZ
85037-3328
US

IV. Provider business mailing address

187 BALLARDVALE ST SUITE 202
WILMINGTON MA
01887-1082
US

V. Phone/Fax

Practice location:
  • Phone: 623-271-9323
  • Fax: 623-321-6588
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

VIII. Authorized Official

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