HAVASU REGIONAL MEDICAL CENTER, LLC (NPI# 1740293950) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740293950 |
| Entity Type | Organization |
| Organization Name | HAVASU REGIONAL MEDICAL CENTER, LLC |
| Other Organization Name | HAVASU REGIONAL MEDICAL CENTER REHABILITATION PROGRAM |
| Practice Address |
101 Civic Center Ln Lake Havasu City AZ 86403-5607 |
| Mailing Address |
103 Powell Ct Brentwood TN 37027-5079 |
| Practice Telephone | 9288558185 |
| Practice Fax Number | 9285055768 |
| Mailing Telephone | 6153728500 |
| Mailing Fax Number | 6153728572 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2019-07-26 |
| Authorized Official Name | KATHY J. TEAGUE (SECRETARY) |
| Authorized Official Telephone | 6153728500 |
| Is Organization Subpart | Y |
| Parent Organization Name | HAVASU REGIONAL MEDICAL CENTER, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273Y00000X | Rehabilitation Unit | SH-2409 | AZ | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | XHSP33227 | 05 | |
| AZ | 445131 | 05 | |
| CA | XHSP43227 | 05 |
| Other Name | Type Code |
|---|---|
| Havasu Regional Medical Center Rehabilitation Program | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871671818 | Havasu Regional Medical Center, LLC | Dietitian, Registered | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2006-11-01 |
| Street Address |
101 CIVIC CENTER LN |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-5607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176233 | Pamela B. Reband | Anesthesiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2005-06-28 |
| 1659995652 | Alana Stern | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2020-06-04 |
| 1245702927 | Michael Barber | Registered Nurse | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2018-12-19 |
| 1891276630 | Brian Andrew | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2018-08-28 |
| 1497264873 | Pinnacle Radiology Services | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-28 |
| 1821516287 | Jaime Wasik | Nurse Practitioner | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-06 |
| 1144776055 | Paul Queior | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2016-08-30 |
| 1891146957 | Misty Maple | Nurse Practitioner | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2016-06-29 |
| 1316319460 | Sarah Fraser | Specialist/Technologist, Other | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2015-10-28 |
| 1780067280 | Samer Asem Haddad | Internal Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2015-07-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 273Y00000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation Unit |
| In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient’s condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient’s medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services. |
| Notes: Source: Code of Federal Regulations #42, Section 412.29. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518376128 | Naana Braly Therapeutic Massage &bodywork | Rehabilitation Unit | 8520 East Shea Blvd Suite 100, Scottsdale, AZ 85260 | 2014-08-07 |
| 1821259185 | Banner Del E Webb Medical Center | Rehabilitation Unit | 14501 W Meeker Blvd, Sun City West, AZ 85375 | 2008-06-19 |
| 1467506857 | Banner -- University Medical Center Phoenix | Rehabilitation Unit | 1012 E Willetta St Fl 3, Phoenix, AZ 85006-2749 | 2007-01-22 |
| 1083668578 | Sun Health Corporation | Rehabilitation Unit | 10601 W Santa Fe Dr, Sun City, AZ 85351-3036 | 2006-05-20 |
| 1235582594 | Dominic Trapp | Rehabilitation Unit | 1000 Fianna Way, Fort Smith, AZ 72919 | 2016-07-21 |
| 1538528955 | Northern Arizona Healthcare | Rehabilitation Unit | 6560 Sr 179, Suite 118, Sedona, AZ 86351-7985 | 2016-02-12 |
| 1710353339 | Smsj Tucson Holdings LLC | Rehabilitation Unit | 1601 W Saint Marys Rd, Tucson, AZ 85745-2623 | 2015-08-18 |
| 1306212923 | Smsj Tucson Holdings LLC | Rehabilitation Unit | 350 N Wilmot Rd, Tucson, AZ 85711-2602 | 2015-08-18 |
| 1669870937 | Vhs of Phoenix Inc | Rehabilitation Unit | 2000 W Bethany Home Rd, Phoenix, AZ 85015-2443 | 2014-12-18 |
| 1073954186 | Northwest Hospital LLC | Rehabilitation Unit | 6200 N La Cholla Blvd, Tucson, AZ 85741-3529 | 2013-07-17 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.