Mingus Mountain Estate Residential Center Inc
Organization Active NPI Assisted Living Facility (Behavioral Disturbances) · Dewey, AZ
NPI 1114090925 · NPPES record last updated Mar 10, 2025
Key facts
- NPI
- 1114090925
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility (Behavioral Disturbances) 3104A0630X
- License
- BH-1122 (AZ)
- Legal business name
- MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
- Practice address
- 100 Dewey Road
Farrington Home
Dewey, AZ 86327 - Phone
- (602) 335-2095
- Fax
- (602) 249-1311
- NPI assigned
- Nov 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Brooke Wilson
- Title
- Senior Credentialing Specialists
- Phone
- (602) 335-2000
Corporate family (same tax ID) 6
Practitioners 4
-
Cheri L Ledsome, FNP-C, PMHNP-BC
-
Kathy Rivera, MD
-
Cybele E Saimo, PMHNP - BC
National Provider Directory
- Tax ID family
- Mingus Mountain Estate Residential Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility (Behavioral Disturbances) | 3104A0630X | BH-1122 | AZ | Yes |
Addresses
Primary practice location
100 Dewey Road
Farrington Home
Dewey, AZ 86327
Mailing address
2517 N Great Western Dr
Prescott Valley, AZ 86314-2597
Phone (602) 335-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 497744 | Medicaid | AZ |
Other names
- Farrington House
Other providers in Dewey, AZ
- Huimin Liu III
- Living Kinetics LLC
- Jessica Dean Marks
- Mary Elizabeth Massieu
- Michael O. Baird D.D.S., P.C.
- Mobile Healthcare Solutions, LLC
- Monreal Family Services, LLC
- Monreal Family Services, LLC
- Toni L Monreal
- Keri Newberry
All providers in Dewey, AZ · Assisted Living Facility (Behavioral Disturbances) in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.