1588715122 NPI number — CENTERRE REHABILITATION HOSPITAL OF ARIZONA, LLC

Table of content: (NPI 1588715122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588715122 NPI number — CENTERRE REHABILITATION HOSPITAL OF ARIZONA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERRE REHABILITATION HOSPITAL OF ARIZONA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHOENIX REHABILITATION HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588715122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7733 FORSYTH BLVD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-1817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-889-2718
Provider Business Mailing Address Fax Number:
314-889-2727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 E ROOSEVELT ST
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-389-5600
Provider Business Practice Location Address Fax Number:
602-389-5627
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KERR
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER, CENTERRE
Authorized Official Telephone Number:
314-889-2726

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  SH 3645 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0209710 . This is a "BCBS OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: F14493 . This is a "ABRAZO ADVANTAGE HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 920604 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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