Provider Demographics
NPI:1770009219
Name:NEURO REHABCARE OF THE VALLEY - AZ LLC
Entity Type:Organization
Organization Name:NEURO REHABCARE OF THE VALLEY - AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-961-6838
Mailing Address - Street 1:10800 FARLEY ST STE 265
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1693
Mailing Address - Country:US
Mailing Address - Phone:913-961-6838
Mailing Address - Fax:913-345-1920
Practice Address - Street 1:8307 W MISTY WILLOW LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1511
Practice Address - Country:US
Practice Address - Phone:623-745-0910
Practice Address - Fax:623-745-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities