Healthcare Provider Details

I. General information

NPI: 1790150100
Provider Name (Legal Business Name): INDEPENDENCE REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 N 68TH ST
SCOTTSDALE AZ
85257-1202
US

IV. Provider business mailing address

5314 NORTH RIVER RUN DRIVE #140
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 480-946-6571
  • Fax:
Mailing address:
  • Phone: 801-426-4953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JULIE LONG
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 801-471-2449