Ponderosa Pines Care and Rehab, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCI-340 Issued in AZ

Legal business name

PONDEROSA PINES CARE AND REHAB, INC

Practice address

800 W University Ave
Flagstaff, AZ 86001-7103

Phone

(928) 779-6931

Fax

(928) 779-2180

NPI assigned

Feb 11, 2009

Organization subpart

No

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

Authorized official

Name

Mr. William Scott Thomas

Title

Systems Administrator

Phone

(801) 296-5106

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1992944151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W UNIVERSITY AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860017103",
            "telephone_number": "928-779-6931",
            "fax_number": "928-779-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W UNIVERSITY AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860017103",
            "telephone_number": "928-779-6931",
            "fax_number": "928-779-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA PINES CARE AND REHAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "SYSTEMS ADMINISTRATOR",
        "authorized_official_telephone_number": "801-296-5106",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "707341",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jesteny-Amber W Poesch
• Barbara Polstein, DO
• Julie Marie Polzin, RN, NP-C
• Aisling Pomeroy-King, CCC-SLP
• Christopher Pomeroy
• Mary Carolina Poore, NATUROPATHIC DOCTOR
• Cezar M Popescu, LPC
• Porvaznik Family Medicine PLLC
• Mary Catherine Porvaznik, MD
• Andrew Post, MA

• Skilled Nursing Facility in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.