Provider Demographics
NPI:1346830247
Name:ESSENTIAL HOME REHAB, PLLC
Entity Type:Organization
Organization Name:ESSENTIAL HOME REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:623-777-1870
Mailing Address - Street 1:14815 W BELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7603
Mailing Address - Country:US
Mailing Address - Phone:623-777-1870
Mailing Address - Fax:623-777-1403
Practice Address - Street 1:14815 W BELL RD STE 110
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7603
Practice Address - Country:US
Practice Address - Phone:623-777-1870
Practice Address - Fax:623-777-1403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUE CARE PHYSICAL THERAPY AND REHABILITATION, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1437347069Medicaid