MEDICARE: INDEPENDENCE REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1790150100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE REHAB

Provider Business Mailing Address
First Line	:	5314 NORTH RIVER RUN DRIVE
Second Line	:	#140
City	:	PROVO
State	:	UT
Zip	:	84604
Country	:	US
Telephone Number	:	801-426-4953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 N 68TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-1202
Country	:	US
Telephone Number	:	480-946-6571
Fax Number	:

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	JULIE LONG
Credential	:
Telephone Number	:	801-471-2449

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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Directions to “INDEPENDENCE REHAB ” Practice Location

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