Healthcare Provider Details

I. General information

NPI: 1649972480
Provider Name (Legal Business Name): REBOUND HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 E BROADMOR DR
TEMPE AZ
85282-2804
US

IV. Provider business mailing address

4960 S GILBERT RD STE 1-481
CHANDLER AZ
85249-6019
US

V. Phone/Fax

Practice location:
  • Phone: 559-312-3377
  • Fax:
Mailing address:
  • Phone: 559-312-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MYISHA ANNALISA PONDEXTER
Title or Position: MEMBER
Credential:
Phone: 559-312-3377