Healthcare Provider Details

I. General information

NPI: 1164677571
Provider Name (Legal Business Name): HERITAGE AT CAREFREE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36590 N. PIMA ROAD
CAREFREE AZ
85377-3481
US

IV. Provider business mailing address

PO BOX 3481
CAREFREE AZ
85377-3481
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-1622
  • Fax:
Mailing address:
  • Phone: 480-488-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberALC-5482
License Number StateAZ

VIII. Authorized Official

Name: DONNA DANIELA HOLBURA
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 480-488-1622