Basic Information
Provider Information | |||||||||
NPI: | 1679209720 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PHOENIX REHABILITATION AND HEALTH SERVICES OF DELAWARE INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
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OtherOrganizationName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 2000 WESTINGHOUSE DR STE 200 | ||||||||
Address2: |   | ||||||||
City: | CRANBERRY TOWNSHIP | ||||||||
State: | PA | ||||||||
PostalCode: | 160665238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7243434060 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 210 LOUVIERS DR | ||||||||
Address2: |   | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197114167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3025335313 | ||||||||
FaxNumber: | 3025337361 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/29/2022 | ||||||||
LastUpdateDate: | 07/29/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | METAL-CONFER | ||||||||
AuthorizedOfficialFirstName: | BRENDA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
AuthorizedOfficialTelephone: | 7245845739 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
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NPICertificationDate: | 07/29/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 225100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.