1386633600 NPI number — NAVAJOLAND NURSING HOMES, INC.

Table of content: (NPI 1386633600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386633600 NPI number — NAVAJOLAND NURSING HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVAJOLAND NURSING HOMES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386633600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINLE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86503-0910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-674-5216
Provider Business Mailing Address Fax Number:
928-674-5218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 191HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
CHINLE NURSING HOME
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503-0910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-5216
Provider Business Practice Location Address Fax Number:
928-674-5218
Provider Enumeration Date:
10/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TRACY
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
R.N. DIRECTOR OF NURSING
Authorized Official Telephone Number:
928-674-5216

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  035242 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 035242 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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