Healthcare Provider Details

I. General information

NPI: 1932148475
Provider Name (Legal Business Name): LA POSADA AT PARK CENTRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S LA POSADA CIR
GREEN VALLEY AZ
85614-5100
US

IV. Provider business mailing address

700 S LA POSADA CIR
GREEN VALLEY AZ
85614-5100
US

V. Phone/Fax

Practice location:
  • Phone: 520-648-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOTC 0533
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI402
License Number StateAZ

VIII. Authorized Official

Name: MR. STEVEN KOLNACKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 520-648-8380