Provider Demographics
NPI:1376602193
Name:AVALON HEALTH & REHAB CENTER-TUCSON LLC
Entity Type:Organization
Organization Name:AVALON HEALTH & REHAB CENTER-TUCSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. POLICY & GOVERNMENT RELATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-0153
Mailing Address - Street 1:255 E 400 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2846
Mailing Address - Country:US
Mailing Address - Phone:801-325-0153
Mailing Address - Fax:801-433-0939
Practice Address - Street 1:1400 N WILMOT RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4409
Practice Address - Country:US
Practice Address - Phone:801-325-0153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035269Medicare Oscar/Certification