Provider Demographics
NPI:1598488447
Name:REHOBOTH HOMES LLC
Entity Type:Organization
Organization Name:REHOBOTH HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWATOFUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-578-5445
Mailing Address - Street 1:3324 E RAY RD UNIT 517
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4525
Mailing Address - Country:US
Mailing Address - Phone:602-578-5445
Mailing Address - Fax:
Practice Address - Street 1:828 S REBER AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1467
Practice Address - Country:US
Practice Address - Phone:602-578-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child