Basic Information
| Provider Information | |||||||||
| NPI: | 1497032247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHAB WITHOUT WALLS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RWW PHOENIX | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 N WHITTINGTON PKWY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402225186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023942100 | ||||||||
| FaxNumber: | 5023942285 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 N DREAMY DRAW DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850204641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028707470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2011 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | MATTINGLY | ||||||||
| AuthorizedOfficialFirstName: | ANGIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER-PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 5023813579 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 253Z00000X | Y | Agencies | In Home Supportive Care |
No ID Information.