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Organization
COMMUNITY & CHILD REHABILITATION SERVICE LLC
Active
Organization
COMMUNITY & CHILD REHABILITATION SERVICE LLC
Active
Other names
Community & Child Rehabilitation Services LLC, Community & Child Rehabilitation Service LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AKANINYENE JAMES ETUKUDOH DNP (PROGRAM DIRECTOR)
(623) 455-1558
Entity
Organization
Contact information
Practice address
14233 W POINSETTIA DR, SURPRISE, AZ 85379-4910
(623) 455-1558
Mailing address
14233 W POINSETTIA DR, SURPRISE, AZ 85379-4910
(623) 455-1558
Taxonomy
Speciality
Code
Description
License number
State
163WR0400X
Rehabilitation Registered Nurse
—
—
177F00000X
Lodging Provider
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
302F00000X
Exclusive Provider Organization
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
11/22/2022
Last updated
08/11/2025
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