Provider Demographics
NPI:1629066550
Name:HEARTHSTONE HOSPITAL SUN CITY
Entity Type:Organization
Organization Name:HEARTHSTONE HOSPITAL SUN CITY
Other - Org Name:TRILLIUM SPECIALTY HOSPITAL WEST VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BYRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-329-2877
Mailing Address - Street 1:13818 N THUNDERBIRD BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2574
Mailing Address - Country:US
Mailing Address - Phone:623-977-1325
Mailing Address - Fax:623-974-3984
Practice Address - Street 1:13818 N THUNDERBIRD BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2574
Practice Address - Country:US
Practice Address - Phone:623-977-1325
Practice Address - Fax:623-974-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI 384314000000X
AZSH 4387314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03-2008OtherMEDICARE
AZ645905Medicaid
AZ645905Medicaid
AZ03-2008OtherMEDICARE