Healthcare Provider Details

I. General information

NPI: 1508620774
Provider Name (Legal Business Name): REHEBOTH OF HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 BASELINE ROAD
ROSEVILEE CA
95747
US

IV. Provider business mailing address

8025 OAK AVE
ROSEVILLE CA
95747-9210
US

V. Phone/Fax

Practice location:
  • Phone: 913-548-2461
  • Fax:
Mailing address:
  • Phone: 913-548-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: JOYCE W KINYUA
Title or Position: QIDP
Credential: RN
Phone: 913-548-2461