Healthcare Provider Details

I. General information

NPI: 1922094044
Provider Name (Legal Business Name): SANTA RITA CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N LA CANADA DR
GREEN VALLEY AZ
85614-3129
US

IV. Provider business mailing address

150 N LA CANADA DR
GREEN VALLEY AZ
85614-3129
US

V. Phone/Fax

Practice location:
  • Phone: 520-625-0178
  • Fax: 520-393-1044
Mailing address:
  • Phone: 520-625-0178
  • Fax: 520-393-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-2649
License Number StateAZ

VIII. Authorized Official

Name: MR. PAUL J SOKOLOWSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 520-625-0178