NPIMap

Organization Active NPI

Northern Arizona Senior Living Community, L.L.C.

  • Skilled Nursing Facility
  • Flagstaff, AZ
National Provider Identifier
1679515449
Registry record updated Feb 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCI-2515 Issued in AZ
Legal business name
NORTHERN ARIZONA SENIOR LIVING COMMUNITY, L.L.C.
Practice address
3150 N Winding Brook Rd
Flagstaff, AZ 86001-0972
Phone
(928) 774-7106
Fax
(928) 213-0831
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2020

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

Authorized official

Name
Randall W Benson
Title
Authorized Official
Phone
(952) 361-8000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X ALC-2517 AZ
Skilled Nursing Facility 314000000X NCI-2515 AZ Primary

Addresses

Primary practice location

3150 N Winding Brook Rd
Flagstaff, AZ 86001-0972

Mailing address

1107 Hazeltine Blvd
Suite 200
Chaska, MN 55318-1009
Phone (952) 361-8000

Other identifiers 7

IdentifierTypeStateIssuer
504698OtherHEALTH CHOICE ARIZONA
504698OtherMERCY CARE PLAN
504698MedicaidAZ
504698OtherIHS-FFS
AZ0206980OtherAZBCBS OF AZ MANAGED CARE
504698OtherEVERCARE SELECT
582230MedicaidAZ

Other names 1

  • THE PEAKS HEALTH & REHABILITATION Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100106000813 AZ Part A Provider - Skilled Nursing Facility 4688715030 Practice locations: Flagstaff, AZ

Skilled nursing facility certification: CCN 035257

Legal name
NORTHERN ARIZONA SENIOR LIVING COMMUNITY, LLC
Doing business as
THE PEAKS HEALTH & REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 3, 2000
Last certification
Nov 7, 2024
Beds
58
Ownership / control type
Other Nonprofit
Organization structure
LLCNon-profit
Incorporated
Dec 24, 1997 in AZ
Enrollment address
3150 N Winding Brook Rd
Flagstaff, AZ 86001-0972
Nursing home name
THE PEAKS HEALTH & REHABILITATION
Affiliated entity
THE GOODMAN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Peaks Health & RehabilitationCCN 035257
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
May 3, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5841.5 residents per day on average
Chain
The Goodman Group9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D0965508Peaks Health & Rehabilitation, the3150 N Winding Brook Rd, Flagstaff, AZ 86001Certificate of waiverSep 21, 2027
03D2166247Northern Arizona Senior Living Community, LLC3150 N Winding Brook Road, Flagstaff, AZ 86001Certificate of waiverMay 13, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jacob Matthew Lansburg Individual Corporate DirectorManager May 27, 2020 16.67%
Clinton V Knacke Individual Corporate OfficerChief Financial Officer Oct 12, 2022 100%
Lisa D Davison Individual Corporate DirectorManager Jan 13, 2020 16.67%
Cameron Loe Farr Individual W-2 Managing EmployeeExecutive Director Apr 1, 2024 100%
Thomas Jay Salmen Individual Corporate Director Jan 1, 2024
Northern Arizona Healthcare Corporation Organization, Flagstaff, AZ 5% Or Greater Direct Ownership Interest Dec 24, 1997 50%
Operational/Managerial Control Dec 24, 1997 50%
Northern Arizona Senior Living Community, LLC Organization, Chaska, MN Created for acquisition, LLC, Non-profit 5% Or Greater Direct Ownership Interest Feb 15, 2017 100%
Operational/Managerial Control Feb 15, 2017 100%
Mark L Wilson Individual Corporate Director Jan 1, 2024
Sadek R Ebeid Individual Contracted Managing EmployeeMD; Sep 16, 2020
Christopher J Bavasi Individual Corporate OfficerManager and Co-Ceo Nov 18, 2015 50%
Corporate DirectorManager and Co-Ceo Nov 18, 2015 16.67%
The Goodman Family Operating Foundation Organization, Chaska, MN Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2024 50%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582243200000",
    "number": "1679515449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 HAZELTINE BLVD",
            "address_2": "SUITE 200",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181009",
            "telephone_number": "952-361-8000",
            "fax_number": "952-361-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N WINDING BROOK RD",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860010972",
            "telephone_number": "928-774-7106",
            "fax_number": "928-213-0831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ARIZONA SENIOR LIVING COMMUNITY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A",
        "authorized_official_last_name": "BENSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "952-361-8000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "ALC-2517",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-2515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CHOICE ARIZONA",
            "identifier": "504698",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY CARE PLAN",
            "identifier": "504698",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504698",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHS-FFS",
            "identifier": "504698",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AZ MANAGED CARE",
            "identifier": "AZ0206980",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE SELECT",
            "identifier": "504698",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "582230",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE PEAKS HEALTH & REHABILITATION",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE PEAKS HEALTH & REHABILITATION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.