Provider Demographics
NPI:1114218062
Name:ARIZONA BAPTIST RETIREMENT CENTERS, INC
Entity Type:Organization
Organization Name:ARIZONA BAPTIST RETIREMENT CENTERS, INC
Other - Org Name:COOK HEALTH CARE REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-933-3333
Mailing Address - Street 1:11527 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1640
Mailing Address - Country:US
Mailing Address - Phone:623-933-3333
Mailing Address - Fax:623-583-1465
Practice Address - Street 1:11527 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1640
Practice Address - Country:US
Practice Address - Phone:623-933-3333
Practice Address - Fax:623-583-1465
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA BAPTIST RETIREMENT CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3090261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)