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General NPI Number Information
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NPI Number | 1205613486
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Entity Type | Organization
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Legal Business Name | VALLEY OF SUN REBIRTH CARE LLC
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 9010 S PRIEST DR APT 3104
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City | TEMPE
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State | AZ
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Zip | 85284-1176
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Country | US
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Telephone | 602-320-4589
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Fax |
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Provider Business Mailing Address
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Address Line | 9010 S PRIEST DR APT 3104
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City | TEMPE
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State | AZ
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Zip | 85284-1176
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Country | US
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Telephone | 602-320-4589
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN WILLIAMS
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Credential |
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Telephone | 602-320-4589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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