Provider Demographics
NPI:1336504380
Name:COPPER SPRINGS HOSPITAL, LLC
Entity Type:Organization
Organization Name:COPPER SPRINGS HOSPITAL, LLC
Other - Org Name:COPPER SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:4801 OLYMPIA PARK PLZ STE 1000
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2090
Mailing Address - Country:US
Mailing Address - Phone:502-916-8830
Mailing Address - Fax:
Practice Address - Street 1:10550 W. MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4864
Practice Address - Country:US
Practice Address - Phone:480-565-3035
Practice Address - Fax:480-565-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ149746Medicaid
AZ034032Medicare Oscar/Certification