Provider Demographics
NPI:1790016244
Name:APACHE JUNCTION HOSPITAL, LLC
Entity Type:Organization
Organization Name:APACHE JUNCTION HOSPITAL, LLC
Other - Org Name:ARIZONA REGIONAL MEDICAL CENTER-APACHE JUNCTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-898-3333
Mailing Address - Street 1:P.O. BOX 52163
Mailing Address - Street 2:MSC # 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2163
Mailing Address - Country:US
Mailing Address - Phone:480-898-3333
Mailing Address - Fax:480-223-4236
Practice Address - Street 1:2050 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-7305
Practice Address - Country:US
Practice Address - Phone:480-237-3200
Practice Address - Fax:480-237-3206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APACHE JUNCTION HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-22
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500470Medicaid
AZ030126Medicare Oscar/Certification