Provider Demographics
NPI:1508581976
Name:REHEMA OUTPATIENT TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:REHEMA OUTPATIENT TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MWANGI
Authorized Official - Last Name:NDUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:503-964-0794
Mailing Address - Street 1:1968A N PEART RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2496
Mailing Address - Country:US
Mailing Address - Phone:480-930-7606
Mailing Address - Fax:
Practice Address - Street 1:1968A N PEART RD STE 3
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2496
Practice Address - Country:US
Practice Address - Phone:480-930-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)