Provider Demographics
NPI:1518014927
Name:PERFORMANCE ENHANCEMENT AND REHABILITATION INC
Entity Type:Organization
Organization Name:PERFORMANCE ENHANCEMENT AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEUVELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-742-9166
Mailing Address - Street 1:3295 W INA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2192
Mailing Address - Country:US
Mailing Address - Phone:520-547-2062
Mailing Address - Fax:520-547-2065
Practice Address - Street 1:3295 W INA RD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2192
Practice Address - Country:US
Practice Address - Phone:520-547-2062
Practice Address - Fax:520-547-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1298I101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1298IOtherLICENSE