Provider Demographics
NPI:1184826711
Name:RELIABLE CONSTRUCTION LLC
Entity Type:Organization
Organization Name:RELIABLE CONSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:480-854-4477
Mailing Address - Street 1:3026 E BACKUS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-3117
Mailing Address - Country:US
Mailing Address - Phone:480-854-4477
Mailing Address - Fax:480-854-4410
Practice Address - Street 1:3026 E BACKUS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-3117
Practice Address - Country:US
Practice Address - Phone:480-854-4477
Practice Address - Fax:480-854-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418534OtherAHCCCS#