Provider Demographics
NPI:1588715122
Name:CENTERRE REHABILITATION HOSPITAL OF ARIZONA, LLC
Entity type:Organization
Organization Name:CENTERRE REHABILITATION HOSPITAL OF ARIZONA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER, CENTERRE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-889-2726
Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:314-889-2718
Mailing Address - Fax:314-889-2727
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-389-5600
Practice Address - Fax:602-389-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH 3645283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0209710OtherBCBS OF ARIZONA
AZF14493OtherABRAZO ADVANTAGE HEALTH
AZ920604Medicaid
AZ920604Medicaid