Healthcare Provider Details

I. General information

NPI: 1134125750
Provider Name (Legal Business Name): INFINIA AT CAMP VERDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E HIGHWAY 260
CAMP VERDE AZ
86322-6864
US

IV. Provider business mailing address

15 E HIGHWAY 260
CAMP VERDE AZ
86322-6864
US

V. Phone/Fax

Practice location:
  • Phone: 928-567-5253
  • Fax: 928-567-3794
Mailing address:
  • Phone: 928-567-5253
  • Fax: 928-567-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-366
License Number StateAZ

VIII. Authorized Official

Name: SCOTT ROBERTSON
Title or Position: OWNER
Credential:
Phone: 801-295-8000