Healthcare Provider Details

I. General information

NPI: 1386010759
Provider Name (Legal Business Name): IRONWOOD ASSISTED LIVING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 W 13TH AVE
APACHE JUNCTION AZ
85120-6269
US

IV. Provider business mailing address

1226 W 13TH AVE
APACHE JUNCTION AZ
85120-6269
US

V. Phone/Fax

Practice location:
  • Phone: 480-474-2111
  • Fax: 480-474-2111
Mailing address:
  • Phone: 480-474-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9190H
License Number StateAZ

VIII. Authorized Official

Name: MS. ALMA LABUAN HENNINGSEN
Title or Position: OWNER
Credential:
Phone: 480-474-2111