Provider Demographics
NPI:1508620774
Name:REHEBOTH OF HOPE LLC
Entity Type:Organization
Organization Name:REHEBOTH OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QIDP
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:KINYUA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:913-548-2461
Mailing Address - Street 1:8025 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9210
Mailing Address - Country:US
Mailing Address - Phone:913-548-2461
Mailing Address - Fax:
Practice Address - Street 1:2495 BASELINE ROAD
Practice Address - Street 2:
Practice Address - City:ROSEVILEE
Practice Address - State:CA
Practice Address - Zip Code:95747
Practice Address - Country:US
Practice Address - Phone:913-548-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility