Provider Demographics
NPI:1528666039
Name:REHOBOTH LLC
Entity type:Organization
Organization Name:REHOBOTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-603-5286
Mailing Address - Street 1:43014 W WILD HORSE TRL # A
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-8274
Mailing Address - Country:US
Mailing Address - Phone:480-603-5286
Mailing Address - Fax:520-200-0357
Practice Address - Street 1:46136 W MOUNTAIN VIEW RD # A
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-6796
Practice Address - Country:US
Practice Address - Phone:480-603-5286
Practice Address - Fax:520-200-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children