Provider Demographics
NPI:1710701438
Name:RED MOUNTAIN REHAB GROUNDWORK LLC
Entity type:Organization
Organization Name:RED MOUNTAIN REHAB GROUNDWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-243-5469
Mailing Address - Street 1:1515 N GILBERT ROAD D107
Mailing Address - Street 2:PB415
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-243-5469
Mailing Address - Fax:877-588-8282
Practice Address - Street 1:15255 N 40TH ST STE 149
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4683
Practice Address - Country:US
Practice Address - Phone:480-243-5469
Practice Address - Fax:877-588-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center