MEDICARE: HAVASU REGIONAL MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1093154130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVASU REGIONAL MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	330 SEVEN SPRINGS WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5098
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:	615-920-8913

Provider Business Practice Location Address
First Line	:	1811 MESQUITE AVE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5668
Country	:	US
Telephone Number	:	928-505-5793
Fax Number	:	928-505-5799

Authorized Official
Title or Position	:	SECRETARY
Name	:	CHARLOTTE LAWRENCE
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	07/31/2023

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