Provider Demographics
NPI:1134201999
Name:REM MEDICAL ARIZONA, LLC
Entity type:Organization
Organization Name:REM MEDICAL ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-783-1441
Mailing Address - Street 1:300 ROSEWOOD DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1384
Mailing Address - Country:US
Mailing Address - Phone:978-774-7243
Mailing Address - Fax:978-774-7421
Practice Address - Street 1:6550 E BROADWAY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1732
Practice Address - Country:US
Practice Address - Phone:480-218-6222
Practice Address - Fax:480-218-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic