Ldrkair

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

ALC-4533 Issued in AZ

Legal business name

LDRKAIR

Practice address

395 W Garden LN
Snowflake, AZ 85937-6218

Phone

(928) 536-7935

Fax

(928) 536-5444

NPI assigned

Nov 4, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Larry Douglas Matyas

Title

Owner

Phone

(928) 536-7935

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• The Carriage House on West Garden Lane Doing business as

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

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257292800000",
    "number": "1386971877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 W GARDEN LN",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859376218",
            "telephone_number": "928-536-7935",
            "fax_number": "928-536-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W GARDEN LN",
            "city": "SNOWFLAKE",
            "state": "AZ",
            "postal_code": "859376218",
            "telephone_number": "928-536-7935",
            "fax_number": "928-536-5444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LDRKAIR",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-04",
        "last_updated": "2009-11-04",
        "status": "A",
        "authorized_official_last_name": "MATYAS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-536-7935",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALC-4533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE PROVIDER SUBSCRIBER ID",
            "identifier": "EVC6003704",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE PROVIDER CAREONE ID",
            "identifier": "28275659",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Carriage House on West Garden Lane",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Bryce Jones, DMD
• Alicia K Laduke, PAC
• LDS Family Services
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• Mark Lindsay, FNP-BC, PMHNP-BC
• Michael Shane Luck, LPC
• William T Meshier, MD

• All providers in Snowflake, AZ
• Adult Care Home Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; 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.