Healthcare Provider Details

I. General information

NPI: 1184802480
Provider Name (Legal Business Name): KINGMAN HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SANTA ROSA DR
KINGMAN AZ
86401-2311
US

IV. Provider business mailing address

3269 STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 928-263-5688
  • Fax: 928-263-5686
Mailing address:
  • Phone: 928-757-0626
  • Fax: 928-692-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberSH5739
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM BLANCHARD
Title or Position: CFO
Credential:
Phone: 928-681-8668