Provider Demographics
NPI:1134576069
Name:REENWALL LLC
Entity type:Organization
Organization Name:REENWALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIMBIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-210-0827
Mailing Address - Street 1:2415W GREENWAY RD # 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023
Mailing Address - Country:US
Mailing Address - Phone:623-210-0827
Mailing Address - Fax:
Practice Address - Street 1:2415 W GREENWAY RD UNIT 3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-4225
Practice Address - Country:US
Practice Address - Phone:623-210-0827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)