Provider Demographics
NPI:1508216201
Name:REHOBOTH AT LAST. LLC
Entity Type:Organization
Organization Name:REHOBOTH AT LAST. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THIMOTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILBOUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-386-1252
Mailing Address - Street 1:533 CABOOSE LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6505
Mailing Address - Country:US
Mailing Address - Phone:928-386-1252
Mailing Address - Fax:
Practice Address - Street 1:533 CABOOSE LN
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6505
Practice Address - Country:US
Practice Address - Phone:928-386-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)