Organization Active NPI

Clearsky Rehabilitation Hospital of West Valley, LLC

  • Rehabilitation Hospital
  • Avondale, AZ
National Provider Identifier
1063168243
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
Legal business name
CLEARSKY REHABILITATION HOSPITAL OF WEST VALLEY, LLC
Practice address
10903 West McDowell Rd
Avondale, AZ 85392
Phone
(623) 404-4417
NPI assigned
Feb 25, 2022
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kristi Duncan
Title
Cfo
Phone
(150) 531-7398

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Clearsky Rehabilitation Hospital of AvondaleCCN 033046
Ownership
For profit
Certified
Aug 4, 2023
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2280596Clearsky Rehabilitation Hospital of Avondale10903 W McDowell Rd, Avondale, AZ 85392Certificate of waiverApr 20, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221214002721 AZ Part A Provider - Hospital 4587033501 Practice locations: Avondale, AZ

Hospital certification: CCN 033046

Legal name
CLEARSKY REHABILITATION HOSPITAL OF WEST VALLEY LLC
Doing business as
CLEARSKY REHAB HOSPITAL OF AVONDALE
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Aug 4, 2023
Last certification
Aug 4, 2023
Beds
30
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jul 31, 2020 in DE
Enrollment address
10903 W McDowell Rd
Avondale, AZ 85392-5003
Main/Primary Hospital Location
Hospital subgroups
Rehabilitation

All disclosed owners & managing parties 19

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
BW Clearsky Aiv IV C Corp Organization, New York, NY Corporation 5% Or Greater Indirect Ownership Interest Nov 17, 2023 9.45%
BW Clearsky Aiv IV Indirect Feeder LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Nov 17, 2023 9.45%
BW Aiv IV Direct Feeder LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Nov 17, 2023 35.21%
Peloton Clearsky Inc Organization, Greenwich, CT Corporation 5% Or Greater Indirect Ownership Interest Nov 17, 2023 44.66%
Kristi L Duncan Individual Corporate OfficerCfo Sep 4, 2020
Peloton Clearsky LLC Organization, Greenwich, CT LLC 5% Or Greater Indirect Ownership Interest Nov 17, 2023 22.33%
Peloton Equity II LP Organization, Greenwich, CT 5% Or Greater Indirect Ownership Interest Nov 17, 2023 22.33%
Claude Darby Brockette Individual Corporate OfficerCeo Sep 4, 2020
Sheryl H Gentile Individual Corporate OfficerVP Sep 4, 2020
Clearsky Health Acquisition LLC Organization, Albuquerque, NM LLC 5% Or Greater Direct Ownership Interest Jul 31, 2020 100%
Leavitt Equity Partners II LP Organization, Salt Lake City, UT 5% Or Greater Indirect Ownership Interest Nov 17, 2023 5.95%
Michael J Warrington Individual Corporate OfficerPresident Dec 2, 2024
Clearsky Health Intermediate LLC Organization, Albuquerque, NM LLC 5% Or Greater Indirect Ownership Interest Jul 31, 2020 100%
Clearsky Employee Holdings-a, LLC Organization, New York, NY LLC 5% Or Greater Indirect Ownership Interest Nov 17, 2023 4.74%
Clearsky Health Holdings LLC Organization, Albuquerque, NM LLC 5% Or Greater Indirect Ownership Interest Jul 31, 2020 100%
Theodore B Lundberg Individual Corporate OfficerVP Sep 4, 2020
Jeremy Michael Kogler Individual Corporate OfficerVP Sep 4, 2020
BW Clearsky Aiv IV LP Organization, New York, NY 5% Or Greater Indirect Ownership Interest Nov 17, 2023 44.66%
Amy Hansen Individual W-2 Managing EmployeeCeo Feb 12, 2024

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

10903 West McDowell Rd
Avondale, AZ 85392

Mailing address

5600 Wyoming Blvd NE Ste 225
Albuquerque, NM 87109-3136
Phone (303) 845-0223

Other names 1

NPPES NPI Registry
  • ClearSky Rehabilitation Hospital of Avondale Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 20, 2023.

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1063168243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 WYOMING BLVD NE STE 225",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093136",
            "telephone_number": "303-845-0223",
            "fax_number": "833-642-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10903 WEST MCDOWELL RD",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "85392",
            "telephone_number": "623-404-4417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARSKY REHABILITATION HOSPITAL OF WEST VALLEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-25",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "150-531-7398"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ClearSky Rehabilitation Hospital of Avondale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avondale, AZ

Sources for this page

Verify at the official NPI Registry.