Healthcare Provider Details

I. General information

NPI: 1730466962
Provider Name (Legal Business Name): LA POSADA AT PARK CENTRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S PARK CENTRE AVE
GREEN VALLEY AZ
85614-5127
US

IV. Provider business mailing address

780 S PARK CENTRE AVE
GREEN VALLEY AZ
85614-5127
US

V. Phone/Fax

Practice location:
  • Phone: 520-625-2273
  • Fax:
Mailing address:
  • Phone: 520-625-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberAL0553D
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN KOLNACKI
Title or Position: DIR. OF HEALTHCARE SERVICES
Credential:
Phone: 520-648-8380