Healthcare Provider Details

I. General information

NPI: 1619595485
Provider Name (Legal Business Name): REHEMA BEHAVIORAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 N 12TH ST
PHOENIX AZ
85014-4203
US

IV. Provider business mailing address

8435 W HUGHES DR
TOLLESON AZ
85353-3902
US

V. Phone/Fax

Practice location:
  • Phone: 602-481-3575
  • Fax:
Mailing address:
  • Phone: 623-256-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE KEMBOI
Title or Position: OWNER
Credential:
Phone: 623-256-7755