Provider Demographics
NPI:1558440495
Name:SAGUARO HEALTH CARE
Entity Type:Organization
Organization Name:SAGUARO HEALTH CARE
Other - Org Name:ACTIVE REHABILITATION, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-546-4449
Mailing Address - Street 1:19424 N R H JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-1409
Mailing Address - Country:US
Mailing Address - Phone:623-546-4449
Mailing Address - Fax:623-546-4480
Practice Address - Street 1:19424 N R H JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-1409
Practice Address - Country:US
Practice Address - Phone:623-546-4449
Practice Address - Fax:623-546-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ809452Medicaid
AZ809452Medicaid