Organization
LAKE PLEASANT HEALTHCARE, INC.
Active
Other names
Lake Pleasant Post Acute Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
SOON BURNAM (TREASURER)
(949) 540-1249
Entity
Organization
Contact information
Practice address
20625 N LAKE PLEASANT RD, PEORIA, AZ 85382-9704
(623) 566-0642
(623) 476-3664
Mailing address
20625 N LAKE PLEASANT RD, PEORIA, AZ 85382-9704
(623) 566-0642
(623) 476-3664
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC9114
AZ DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
04/29/2019
Last updated
04/29/2019
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