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Organization
PARK WAVERLY HEALTHCARE LLC
Active
Organization
PARK WAVERLY HEALTHCARE LLC
Active
Other names
Park Avenue Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
SOON BURNAM (TREASURER)
(949) 540-1249
Entity
Organization
Contact information
Practice address
2001 N PARK AVE, TUCSON, AZ 85719-3558
(520) 882-6151
(520) 620-1547
Mailing address
2001 N PARK AVE, TUCSON, AZ 85719-3558
(520) 882-6151
(520) 620-1547
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC9390
AZ DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
04/29/2019
Last updated
04/29/2019
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