Healthcare Provider Details

I. General information

NPI: 1619734654
Provider Name (Legal Business Name): REXHILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 BOARDMAN CANFIELD RD STE C1
BOARDMAN OH
44512-4387
US

IV. Provider business mailing address

143 BOARDMAN CANFIELD RD STE 323
BOARDMAN OH
44512-4804
US

V. Phone/Fax

Practice location:
  • Phone: 330-728-1092
  • Fax:
Mailing address:
  • Phone: 330-728-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY BRANHAM
Title or Position: OWNER
Credential: NP
Phone: 330-819-8853