Organization
INNOVATIVE REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ROBERT GUZMAN (PRESIDENT)
(602) 300-3391
Entity
Organization
Contact information
Practice address
5146 W WHISPERING WIND DR, GLENDALE, AZ 85310-2910
(623) 738-0479
(623) 738-0479
Mailing address
5146 W WHISPERING WIND DR, GLENDALE, AZ 85310-2910
(623) 738-0479
(623) 738-0479
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
OTC5691
AZ
Other
Enumeration date
04/04/2013
Last updated
07/29/2013
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