Organization
JAGGED ROCK REHAB TRAVELERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIKA SHUMBOPOISSANT OTR (OWNER)
(605) 430-9361
Entity
Organization
Contact information
Practice address
10667 S AVENUE 10 E # 46, YUMA, AZ 85365-7008
(605) 430-9361
Mailing address
10667 S AVENUE 10 E # 46, YUMA, AZ 85365-7008
(605) 430-9361
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
DDD704011
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3025
ARIZONA DEPARTMENT OF ECONOMIC SECURITY DIVISION OF DEVELOPMENTAL DISABILITIES
AZ
Enumeration date
05/13/2009
Last updated
05/13/2009
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