Willow Canyon Healthcare LLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

WILLOW CANYON HEALTHCARE LLC

Doing business as

Pueblo Springs Rehabilitation Center

Practice address

5545 E Lee St
Tucson, AZ 85712-4205

Phone

(520) 296-2306

Fax

(520) 296-4072

NPI assigned

Nov 13, 2020

Organization subpart

No

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

Addresses

Other names 1

• Pueblo Springs Rehabilitation Center Doing business as

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.

• Willow Canyon Healthcare LLC

  dba Pueblo Springs Rehabilitation Center

  • Skilled Nursing Facility
  • Tucson, AZ
  • NPI 1861916686
  NPD tax ID

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

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1932701075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5545 E LEE ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124205",
            "telephone_number": "520-296-2306",
            "fax_number": "520-296-4072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5545 E LEE ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124205",
            "telephone_number": "520-296-2306",
            "fax_number": "520-296-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CANYON HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pueblo Springs Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pueblo Springs Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria A Willis
• Bradley Steven Willison, LCSW
• Grace Willoughby
• Sarah B Prihoda Willoughby, P.T.
• Willow Canyon Healthcare LLC (Pueblo Springs Rehabilitation Center)
• Willow Dermatology, PLLC
• Willow Spring Behavioral Health LLC (Willow Springs Behavioral Health)
• Shay Michael Wills, LAC
• Samantha Willy-Gravley
• Mario Wilmath, PHARMD

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.