Provider Demographics
NPI:1750356523
Name:ACADIA REHABILITATION, LLC
Entity type:Organization
Organization Name:ACADIA REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-583-6573
Mailing Address - Street 1:13260 N 94TH DR
Mailing Address - Street 2:STE 205
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4240
Mailing Address - Country:US
Mailing Address - Phone:623-583-6573
Mailing Address - Fax:623-583-6571
Practice Address - Street 1:13260 N 94TH DR
Practice Address - Street 2:STE 205
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4240
Practice Address - Country:US
Practice Address - Phone:623-583-6573
Practice Address - Fax:623-583-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3883224Z00000X, 2251C2600X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ034524OtherMEDICARE ID-PIN
AZOTC3883OtherOUTPATIENT TREATMENT CTR
AZZ034524OtherMEDICARE ID-PIN