Provider Demographics
NPI:1932701075
Name:WILLOW CANYON HEALTHCARE LLC
Entity Type:Organization
Organization Name:WILLOW CANYON HEALTHCARE LLC
Other - Org Name:PUEBLO SPRINGS REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:5545 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4205
Mailing Address - Country:US
Mailing Address - Phone:520-296-2306
Mailing Address - Fax:520-296-4072
Practice Address - Street 1:5545 E LEE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4205
Practice Address - Country:US
Practice Address - Phone:520-296-2306
Practice Address - Fax:520-296-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)