Boulder Gardens Assistant Living, LLC
Organization Active NPI Assisted Living Facility · Prescott, AZ
NPI 1114262292 · NPPES record last updated Nov 30, 2012
Key facts
- NPI
- 1114262292
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- AL1494C (AZ)
- Legal business name
- BOULDER GARDENS ASSISTANT LIVING, LLC
- Practice address
- 860 Dougherty St
Prescott, AZ 86305-1841 - Phone
- (928) 778-9667
- Fax
- (520) 393-1044
- NPI assigned
- Nov 30, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Carl Zimmerman
- Title
- Senior Vice President
- Phone
- (520) 352-3019
National Provider Directory
Locations
150 N La Canada Dr
Green Valley, AZ 85614
Phone (520) 230-4532
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL1494C | AZ | Yes |
Addresses
Primary practice location
860 Dougherty St
Prescott, AZ 86305-1841
Mailing address
150 N la Canada Dr
Green Valley, AZ 85614-3129
Phone (520) 352-3018
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AL1494C | Other | AZ | STATE LICENSE |
Other providers in Prescott, AZ
- Janet Bontrager
- Ronald Bookman
- April Boothe
- Lawrence H Borish
- Zabrina Boudreau
- Jerry Joseph Bourassa
- Tana Bourdage-Allman
- Carolyn Bourgois
- Sharon Ann Bowen
- Peter J Bower
All providers in Prescott, AZ · Assisted Living Facility in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2012. 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.