Basic Information
| Provider Information | |||||||||
| NPI: | 1831336098 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APACHE JUNCTION HOSPITAL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARIZONA REGIONAL MEDICAL CENTER'S ACUTE REHABILITATION UNIT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 52163 | ||||||||
| Address2: | MSC # 170 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850722163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808983333 | ||||||||
| FaxNumber: | 4804646063 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 N MESA DR | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852015914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808983333 | ||||||||
| FaxNumber: | 4804646383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 01/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | COPE | ||||||||
| AuthorizedOfficialFirstName: | BRENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4808983333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | APACHE JUNCTION HOSPITAL, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | H 4476 | AZ | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 386576 | 05 | AZ | MEDICAID |