NPIMap

Organization Active NPI

Park Waverly Healthcare LLC

Doing business as Park Avenue Health and Rehabilitation Center

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Tucson, AZ
National Provider Identifier
1003470634
Registry record updated Apr 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
PARK WAVERLY HEALTHCARE LLC
Doing business as
Park Avenue Health and Rehabilitation Center
Practice address
2001 N Park Ave
Tucson, AZ 85719-3558
Phone
(520) 882-6151
Fax
(520) 620-1547
NPI assigned
Apr 29, 2019
Last updated
Apr 29, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary

Addresses

Primary practice location

2001 N Park Ave
Tucson, AZ 85719-3558

Mailing address

2001 N Park Ave
Tucson, AZ 85719-3558
Phone (520) 882-6151

Other identifiers 1

IdentifierTypeStateIssuer
OTC9390OtherAZAZ DEPARTMENT OF HEALTH SERVICES

Other names 1

  • Park Avenue Health and Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Esolutions Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556496000000",
    "number": "1003470634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 N PARK AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857193558",
            "telephone_number": "520-882-6151",
            "fax_number": "520-620-1547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 N PARK AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857193558",
            "telephone_number": "520-882-6151",
            "fax_number": "520-620-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK WAVERLY HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-29",
        "last_updated": "2019-04-29",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ DEPARTMENT OF HEALTH SERVICES",
            "identifier": "OTC9390",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Avenue Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.