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NPI Code Detail

MEDICARE: KINGMAN SENIOR LIVING, LLC

MEDICARE: KINGMAN SENIOR LIVING, LLC
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
1310400000XAssisted Living Facility

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 : 1730653361
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINGMAN SENIOR LIVING, LLC
Provider Business Mailing Address
First Line : 2020 W RUDASILL RD
Second Line :
City : TUCSON
State : AZ
Zip : 85704-7800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3600 PETERSON RD
Second Line :
City : KINGMAN
State : AZ
Zip : 86409-3276
Country : US
Telephone Number : 928-681-1050
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : DAVID FRESHWATER
Credential :
Telephone Number : 520-797-4000
Provider Enumeration Date : 01/16/2019
Last Update Date : 01/19/2023

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Directions to “KINGMAN SENIOR LIVING, LLC ” Practice Location

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