Provider Demographics
NPI:1851359145
Name:REHAB ARIZONA NEURO REHABILITATION, LLC
Entity Type:Organization
Organization Name:REHAB ARIZONA NEURO REHABILITATION, LLC
Other - Org Name:NATIONAL NEURO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-831-5050
Mailing Address - Street 1:2725 WATER RIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4580
Mailing Address - Country:US
Mailing Address - Phone:704-831-5050
Mailing Address - Fax:704-831-5072
Practice Address - Street 1:2919 S ELLSWORTH RD
Practice Address - Street 2:STE 111
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2144
Practice Address - Country:US
Practice Address - Phone:866-817-1788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation