Provider Demographics
NPI:1760517312
Name:GRAHAM COUNTY REHABILITATION CENTER
Entity Type:Organization
Organization Name:GRAHAM COUNTY REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-428-7968
Mailing Address - Street 1:502 W MAIN ST
Mailing Address - Street 2:POB 807
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2727
Mailing Address - Country:US
Mailing Address - Phone:928-428-7968
Mailing Address - Fax:928-428-8766
Practice Address - Street 1:502 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2727
Practice Address - Country:US
Practice Address - Phone:928-428-7968
Practice Address - Fax:928-428-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA01CP0001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ622961OtherAHCCCS #