Provider Demographics
NPI:1326001066
Name:NATIONAL HOME REHAB INC
Entity Type:Organization
Organization Name:NATIONAL HOME REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:L
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-291-1666
Mailing Address - Street 1:5025 N CENTRAL AVE
Mailing Address - Street 2:#610
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1520
Mailing Address - Country:US
Mailing Address - Phone:661-291-1666
Mailing Address - Fax:661-291-1616
Practice Address - Street 1:24791 VALLEY ST
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2628
Practice Address - Country:US
Practice Address - Phone:661-291-1666
Practice Address - Fax:661-291-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4136410001Medicare NSC