Jagged Rock Rehab Travelers

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

DDD704011 Issued in AZ

Legal business name

JAGGED ROCK REHAB TRAVELERS

Practice address

10667 S Avenue 10 E # 46
Yuma, AZ 85365-7008

Phone

(605) 430-9361

NPI assigned

May 13, 2009

Organization subpart

No

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

Authorized official

Name

Monika Shumbopoissant, OTR

Title

Owner

Phone

(605) 430-9361

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1700010154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10667 S AVENUE 10 E # 46",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853657008",
            "telephone_number": "605-430-9361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10667 S AVENUE 10 E # 46",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853657008",
            "telephone_number": "605-430-9361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAGGED ROCK REHAB TRAVELERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-13",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "SHUMBOPOISSANT",
        "authorized_official_first_name": "MONIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-430-9361",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "AZ",
            "license": "DDD704011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA DEPARTMENT OF ECONOMIC SECURITY DIVISION OF DEVELOPMENTAL DISABILITIES",
            "identifier": "3025",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamar Jackson, MBA, M.S, BCBA, LBA
• Patricia Jacobo
• Kathy Ann Jacobson, PMHNP-BC
• Jagani Medical Services P.L.L.C.
• Ravi Pankajbhai Jagani, MD
• Rebecca Jaime, RBT
• Aileen G Jakaub, RN
• Urba Jalal, MD
• Jonathan Jans Padilla
• Melissa Bico Jardeleza, RPH

• Early Intervention Provider Agency in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Early Intervention Provider Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; 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.