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NPI Code Detail

MEDICARE: ANASAZI HEALTH CARE, INC.

MEDICARE: ANASAZI HEALTH CARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNCI1209AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063411981
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANASAZI HEALTH CARE, INC.
Provider Business Mailing Address
First Line : 2781 OSBORN DR
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86406-8629
Country : US
Telephone Number : 928-505-5552
Fax Number : 928-505-2660
Provider Business Practice Location Address
First Line : 2781 OSBORN DR
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86406-8629
Country : US
Telephone Number : 928-505-5552
Fax Number : 928-505-2660
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. PAULA MITCHELL
Credential :
Telephone Number : 928-505-5552
Provider Enumeration Date : 07/21/2005
Last Update Date : 06/17/2015

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