Healthcare Provider Details

I. General information

NPI: 1720745664
Provider Name (Legal Business Name): COLDWATER SPRINGS HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E LA CANADA BLVD
AVONDALE AZ
85323-1643
US

IV. Provider business mailing address

350 E LA CANADA BLVD
AVONDALE AZ
85323-1643
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-2282
  • Fax:
Mailing address:
  • Phone: 623-932-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249