Provider Demographics
NPI:1407480254
Name:COPPER SPRINGS HOSPITAL, LLC
Entity Type:Organization
Organization Name:COPPER SPRINGS HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-496-5959
Mailing Address - Street 1:101 S 5TH ST STE 3850
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3127
Mailing Address - Country:US
Mailing Address - Phone:502-792-9864
Mailing Address - Fax:502-719-1757
Practice Address - Street 1:3755 S ROME ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7361
Practice Address - Country:US
Practice Address - Phone:480-667-5500
Practice Address - Fax:480-667-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPPER SPRINGS HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-02
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSH7665OtherARIZONA DEPARTMENT OF HEALTH SERVICES