Provider Demographics
NPI:1417978305
Name:REHOBOTH, INCORPORATED
Entity type:Organization
Organization Name:REHOBOTH, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-968-5858
Mailing Address - Street 1:900 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-6606
Mailing Address - Country:US
Mailing Address - Phone:479-968-5858
Mailing Address - Fax:479-890-6013
Practice Address - Street 1:2004 N 2ND ST
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-2601
Practice Address - Country:US
Practice Address - Phone:479-968-5858
Practice Address - Fax:479-890-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR353320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities