Provider Demographics
NPI:1710204433
Name:FLORENCE HOSPITAL, LLC
Entity Type:Organization
Organization Name:FLORENCE HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:208-249-0011
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3000
Mailing Address - Country:US
Mailing Address - Phone:520-868-3000
Mailing Address - Fax:
Practice Address - Street 1:450 W ADAMSVILLE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132
Practice Address - Country:US
Practice Address - Phone:520-868-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHCARE OF FLORENCE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-21
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH4884261QC0050X, 275N00000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ573850Medicaid
AZ030129Medicare Oscar/Certification
AZ573850Medicaid
030129Medicare Oscar/Certification
AZ03Z316Medicare Oscar/Certification