Provider Demographics
NPI:1518688746
Name:ADVANCED NEUROLOGIC REHABILITATION
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:ATRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-699-4845
Mailing Address - Street 1:3160 N ARIZONA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7122
Mailing Address - Country:US
Mailing Address - Phone:480-699-4845
Mailing Address - Fax:480-699-5085
Practice Address - Street 1:3961 E GUADALUPE RD STE 1
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3266
Practice Address - Country:US
Practice Address - Phone:480-699-4845
Practice Address - Fax:480-699-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation