Healthcare Provider Details

I. General information

NPI: 1689170813
Provider Name (Legal Business Name): EAST VALLEY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S DOBSON RD
CHANDLER AZ
85248-4906
US

IV. Provider business mailing address

6030 S RICE AVE STE C
HOUSTON TX
77081-2944
US

V. Phone/Fax

Practice location:
  • Phone: 713-660-0555
  • Fax:
Mailing address:
  • Phone: 713-660-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: TOM VO
Title or Position: CEO
Credential:
Phone: 713-660-0557