Healthcare Provider Details

I. General information

NPI: 1366641219
Provider Name (Legal Business Name): SAGUARO REHABILITATION AND AQUATIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N PLAZA DR
APACHE JUNCTION AZ
85220-5505
US

IV. Provider business mailing address

305 N PLAZA DR
APACHE JUNCTION AZ
85120-5505
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-7794
  • Fax: 480-982-0747
Mailing address:
  • Phone: 480-982-7794
  • Fax: 480-982-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLAIRE LANSING
Title or Position: OWNER
Credential: MSW
Phone: 480-982-7794