Healthcare Provider Details

I. General information

NPI: 1104373364
Provider Name (Legal Business Name): ARIZONA REHAB CAMPUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 E TANQUE VERDE RD
TUCSON AZ
85715
US

IV. Provider business mailing address

6944 E TANQUE VERDE RD
TUCSON AZ
85715-5308
US

V. Phone/Fax

Practice location:
  • Phone: 844-272-5608
  • Fax:
Mailing address:
  • Phone: 520-526-1028
  • Fax: 520-777-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberIFBH8264
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberIFBH8264
License Number StateAZ

VIII. Authorized Official

Name: MS. NICOLE WILLIAMS
Title or Position: CLAIMS MGR
Credential:
Phone: 520-526-1028