Organization
ALRENWALD-THERANOVA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND LANCE WALDROP (BUSINESS MANAGER)
(928) 376-6650
Entity
Organization
Contact information
Practice address
2359 W 13TH LN, YUMA, AZ 85364-4376
(928) 376-6650
(928) 343-7990
Mailing address
2359 W 13TH LN, YUMA, AZ 85364-4376
(928) 376-6650
(928) 343-7990
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
01/11/2008
Last updated
06/26/2008
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