Healthcare Provider Details

I. General information

NPI: 1710204433
Provider Name (Legal Business Name): FLORENCE HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W ADAMSVILLE RD
FLORENCE AZ
85132
US

IV. Provider business mailing address

PO BOX 1589
FLORENCE AZ
85132-3000
US

V. Phone/Fax

Practice location:
  • Phone: 520-868-3000
  • Fax:
Mailing address:
  • Phone: 520-868-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License NumberH4884
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH4884
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberH4884
License Number StateAZ

VIII. Authorized Official

Name: BRENT CHERNE
Title or Position: CFO
Credential: CPA
Phone: 208-249-0011