Provider Demographics
NPI:1649725193
Name:DIGNITY-LIFEPOINT REHABILITATION HOSPITAL EAST VALLEY LLC
Entity type:Organization
Organization Name:DIGNITY-LIFEPOINT REHABILITATION HOSPITAL EAST VALLEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-594-5400
Mailing Address - Street 1:1515 W. CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6141
Mailing Address - Country:US
Mailing Address - Phone:480-389-9529
Mailing Address - Fax:
Practice Address - Street 1:1515 W. CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6141
Practice Address - Country:US
Practice Address - Phone:480-389-9529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033040Medicare Oscar/Certification