NPIMap

Organization Active NPI

Ponderosa Senior Assisted Living, LLC

  • Clinic/Center
  • Bellemont, AZ
National Provider Identifier
1841474723
Registry record updated Dec 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PONDEROSA SENIOR ASSISTED LIVING, LLC
Practice address
4490 N Bellemont Springs
Bellemont, AZ 86015
Phone
(928) 213-1187
NPI assigned
Dec 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2007

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

Authorized official

Name
Lisa E Kennedy
Title
Owner
Phone
(928) 213-1187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X AZ Primary

Addresses

Primary practice location

4490 N Bellemont Springs
Bellemont, AZ 86015

Mailing address

PO Box 16193
Bellemont, AZ 86015
Phone (928) 213-1187

Other identifiers 1

IdentifierTypeStateIssuer
ALH6417OtherAZASSISTED LIVING

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1841474723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16193",
            "city": "BELLEMONT",
            "state": "AZ",
            "postal_code": "86015",
            "telephone_number": "928-213-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4490 N BELLEMONT SPRINGS",
            "city": "BELLEMONT",
            "state": "AZ",
            "postal_code": "86015",
            "telephone_number": "928-213-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA SENIOR ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-213-1187"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSISTED LIVING",
            "identifier": "ALH6417",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellemont, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; 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.