Organization
ICE CAP REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNETH C PANALIGAN RN (MEMBER)
(630) 369-8450
Entity
Organization
Contact information
Practice address
10451 W PALMERAS DR, SUITE 237W, SUN CITY, AZ 85373-2011
(623) 933-1896
(623) 933-4015
Mailing address
10451 W PALMERAS DR, SUITE 115, SUN CITY, AZ 85373-2011
(623) 933-1896
(623) 933-4015
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629212691
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
04/22/2009
Last updated
11/18/2009
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