Provider Demographics
NPI:1982020764
Name:SENTINEL PEAK HEALTHCARE LLC
Entity Type:Organization
Organization Name:SENTINEL PEAK HEALTHCARE LLC
Other - Org Name:CASAS ADOBES POST ACUTE 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 1:1919 W MEDICAL ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1133
Mailing Address - Country:US
Mailing Address - Phone:520-297-8311
Mailing Address - Fax:520-544-0930
Practice Address - Street 1:1919 W MEDICAL ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1133
Practice Address - Country:US
Practice Address - Phone:520-297-8311
Practice Address - Fax:520-544-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035070Medicare Oscar/Certification