| NPI | 1336858075 |
|---|---|
| Former Legal Business Name | COMMUNITY & CHILD REHABILITATION SERVICES LLC |
| Entity Type | Organization |
| Authorized Contact | AKANINYENE JAMES ETUKUDOH Manager / Statutory Agent 623-455-1558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WR0400X Registered Nurse, Rehabilitation |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health |
| 177F00000X Lodging | |
| 251C00000X | |
| 252Y00000X Early Intervention Provider Agency | |
| 253Z00000X In Home Supportive Care | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QH0100X Clinic/Center, Health Services | |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| 302F00000X Exclusive Provider Organization | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2022-11-22 |