Provider Demographics
NPI:1326224189
Name:ALRENWALD-THERANOVA, LLC
Entity Type:Organization
Organization Name:ALRENWALD-THERANOVA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:WALDROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-376-6650
Mailing Address - Street 1:2359 W 13TH LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4376
Mailing Address - Country:US
Mailing Address - Phone:928-376-6650
Mailing Address - Fax:928-343-7990
Practice Address - Street 1:2359 W 13TH LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4376
Practice Address - Country:US
Practice Address - Phone:928-376-6650
Practice Address - Fax:928-343-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation