Healthcare Provider Details

I. General information

NPI: 1366681520
Provider Name (Legal Business Name): LA SOLANA CARE AND REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N SAN ANTONIO AVE
DOUGLAS AZ
85607-2434
US

IV. Provider business mailing address

1400 N SAN ANTONIO AVE
DOUGLAS AZ
85607-2434
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-7937
  • Fax: 520-805-9146
Mailing address:
  • Phone: 520-364-7937
  • Fax: 520-805-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-388
License Number StateAZ

VIII. Authorized Official

Name: MR. WILLIAM SCOTT THOMAS
Title or Position: SYSTEMS ADMINISTRATOR
Credential:
Phone: 801-296-5106