Organization · NPI-2

Community & Child Rehabilitation Service LLC

In Home Supportive Care · Surprise, AZ

NPI number1336858075

StatusActive

Last updated in NPPESAug 11, 2025

Details

NPI: 1336858075
Entity type: Organization (NPI-2)
Legal business name: Community & Child Rehabilitation Service LLC
Organization subpart: No
Enumeration date: Nov 22, 2022
Certification date: Aug 11, 2025
Last updated: Aug 11, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
253Z00000X	In Home Supportive Care	–	–	Yes
163WR0400X	Registered Nurse, Rehabilitation	–	–
177F00000X	Lodging	–	–
251C00000X	Day Training, Developmentally Disabled Services	–	–
252Y00000X	Early Intervention Provider Agency	–	–
261QD1600X	Clinic/Center, Developmental Disabilities	–	–
261QH0100X	Clinic/Center, Health Services	–	–
276400000X	Rehabilitation, Substance Use Disorder Unit	–	–
302F00000X	Exclusive Provider Organization	–	–
315P00000X	Intermediate Care Facility, Intellectual Disabilities	–	–
320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities	–	–
343900000X	Non-emergency Medical Transport (VAN)	–	–
385HR2060X	Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child	–	–

Other names

Community & Child Rehabilitation Services LLC (Doing Business As)
Community & Child Rehabilitation Service LLC (Other Name)

Practice location

14233 W Poinsettia Dr
Surprise, AZ 85379-4910

Phone 623-455-1558

Mailing address

14233 W Poinsettia Dr
Surprise, AZ 85379-4910

Phone 623-455-1558

Authorized official

Akaninyene James Etukudoh
Program Director
6234551558

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