Provider Demographics
NPI:1750662284
Name:RIM COUNTRY REHABILITATION, INC.
Entity Type:Organization
Organization Name:RIM COUNTRY REHABILITATION, INC.
Other - Org Name:RIM COUNTRY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-474-1120
Mailing Address - Street 1:807 W LONGHORN RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4263
Mailing Address - Country:US
Mailing Address - Phone:928-474-1120
Mailing Address - Fax:928-474-0505
Practice Address - Street 1:807 W LONGHORN RD
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4263
Practice Address - Country:US
Practice Address - Phone:928-474-1120
Practice Address - Fax:928-474-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 4934314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341077Medicaid
AZ341077Medicaid