Slo Austin House, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL8288C Issued in AZ

Legal business name

SLO AUSTIN HOUSE, LLC

Doing business as

Austin House Assisted Living

Practice address

195 S Willard St
Cottonwood, AZ 86326-4123

Phone

(928) 634-4278

NPI assigned

Mar 17, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janya Ricca

Title

Executive Director

Phone

(928) 634-4278

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Austin House Assisted Living Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1366741225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 S WILLARD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264123",
            "telephone_number": "928-634-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 S WILLARD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264123",
            "telephone_number": "928-634-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLO AUSTIN HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "RICCA",
        "authorized_official_first_name": "JANYA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "928-634-4278"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL8288C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER NUMBER",
            "identifier": "580662",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Austin House Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Isabelle Shook, LPC
• Angela Joy Siatta, RN
• Jugraj Singh, M.D.
• Sourabh Singh, M.D.
• Scott Skipper, PTA
• Alison Morgan Smith, PHARMD
• Larry Derrell Smith, PA-C
• Patricia Anne Smith, M.D.
• Phillip Wayne Smith, DNP
• Valerie Smith, SLPA

• Assisted Living Facility in Cottonwood, AZ
• Providers in Cottonwood, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.