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General NPI Number Information
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NPI Number | 1710701438
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Entity Type | Organization
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Legal Business Name | RED MOUNTAIN REHAB GROUNDWORK LLC
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Dates
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Enumeration Date | 11/09/2024
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Last Update Date | 11/09/2024
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Provider Practice Location Address
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Address Line | 15255 N 40TH ST STE 149
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City | PHOENIX
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State | AZ
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Zip | 85032-4683
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Country | US
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Telephone | 480-243-5469
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Fax | 877-588-8282
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Provider Business Mailing Address
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Address Line | 1515 N GILBERT ROAD D107 PB415
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City | GILBERT
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State | AZ
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Zip | 85234
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Country | US
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Telephone | 480-243-5469
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Fax | 877-588-8282
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Authorized Official
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Title or Position | CEO
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Name | MS. JENNIFER ALLEN
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Credential |
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Telephone | 480-243-5469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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