Organization
LEFT OF BANG LCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BROCK M BEVELL (DIRECTOR)
(928) 826-3833
Entity
Organization
Contact information
Practice address
1201 E COOLEY ST STE D, SHOW LOW, AZ 85901-5145
(928) 826-3833
Mailing address
1201 E COOLEY ST STE D, SHOW LOW, AZ 85901-5145
(928) 826-3833
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
12/28/2018
Last updated
12/28/2018
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