NPIMap

Organization Active NPI

Innovative Rehabilitation LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Glendale, AZ
National Provider Identifier
1114260494
Registry record updated Jul 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
License
OTC5691 Issued in AZ
Legal business name
INNOVATIVE REHABILITATION LLC
Practice address
5146 W Whispering Wind Dr
Glendale, AZ 85310-2910
Phone
(623) 738-0479
Fax
(623) 738-0479
NPI assigned
Apr 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charles Robert Guzman
Title
President
Phone
(602) 300-3391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X OTC5691 AZ Primary

Addresses

Primary practice location

5146 W Whispering Wind Dr
Glendale, AZ 85310-2910

Mailing address

5146 W Whispering Wind Dr
Glendale, AZ 85310-2910
Phone (623) 738-0479

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375056000000",
    "number": "1114260494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5146 W WHISPERING WIND DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853102910",
            "telephone_number": "623-738-0479",
            "fax_number": "623-738-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5146 W WHISPERING WIND DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853102910",
            "telephone_number": "623-738-0479",
            "fax_number": "623-738-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-04",
        "last_updated": "2013-07-29",
        "status": "A",
        "authorized_official_last_name": "GUZMAN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-300-3391"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "AZ",
            "license": "OTC5691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.