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General NPI Number Information
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NPI Number | 1649972480
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Entity Type | Organization
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Legal Business Name | REBOUND HEALTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 1839 E BROADMOR DR
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City | TEMPE
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State | AZ
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Zip | 85282-2804
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Country | US
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Telephone | 559-312-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 4960 S GILBERT RD STE 1-481
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City | CHANDLER
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State | AZ
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Zip | 85249-6019
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Country | US
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Telephone | 559-312-3377
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MYISHA ANNALISA PONDEXTER
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Credential |
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Telephone | 559-312-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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