Provider Demographics
NPI:1831336098
Name:APACHE JUNCTION HOSPITAL, LLC
Entity type:Organization
Organization Name:APACHE JUNCTION HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
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:480-464-6063
Practice Address - Street 1:515 N MESA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5914
Practice Address - Country:US
Practice Address - Phone:480-898-3333
Practice Address - Fax:480-464-6383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APACHE JUNCTION HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-09
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH 4476273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ386576Medicaid
AZ03T126Medicare PIN