Provider Demographics
NPI:1073572590
Name:PROMISE HOSPITAL OF PHOENIX INC
Entity Type:Organization
Organization Name:PROMISE HOSPITAL OF PHOENIX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-869-3100
Mailing Address - Street 1:999 YAMATO ROAD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-869-3100
Mailing Address - Fax:561-826-0171
Practice Address - Street 1:433 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-7104
Practice Address - Country:US
Practice Address - Phone:480-427-3006
Practice Address - Fax:480-427-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH 3406282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0420090OtherBLUE CROSS PROVIDER #
AZ836174Medicaid
AZAZ0420090OtherBLUE CROSS PROVIDER #