Provider Demographics
NPI:1447547401
Name:SPA-AAAH AT REGENT HEALTHCARE, INC
Entity type:Organization
Organization Name:SPA-AAAH AT REGENT HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-234-9436
Mailing Address - Street 1:4110 N SCOTTSDALE RD STE 325
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4423
Mailing Address - Country:US
Mailing Address - Phone:480-609-4244
Mailing Address - Fax:480-609-4382
Practice Address - Street 1:4110 N SCOTTSDALE RD STE 325
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4423
Practice Address - Country:US
Practice Address - Phone:480-609-4244
Practice Address - Fax:480-609-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4276225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty