Healthcare Provider Details

I. General information

NPI: 1114218062
Provider Name (Legal Business Name): ARIZONA BAPTIST RETIREMENT CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11527 W PEORIA AVE
YOUNGTOWN AZ
85363-1640
US

IV. Provider business mailing address

11527 W PEORIA AVE
YOUNGTOWN AZ
85363-1640
US

V. Phone/Fax

Practice location:
  • Phone: 623-933-3333
  • Fax: 623-583-1465
Mailing address:
  • Phone: 623-933-3333
  • Fax: 623-583-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License NumberOTC3090
License Number StateAZ

VIII. Authorized Official

Name: ROD KEMP
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 623-933-3333