Healthcare Provider Details

I. General information

NPI: 1265432777
Provider Name (Legal Business Name): THE LINGENFELTER CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 SUNRISE AVE
KINGMAN AZ
86401
US

IV. Provider business mailing address

1099 SUNRISE AVE
KINGMAN AZ
86401-6825
US

V. Phone/Fax

Practice location:
  • Phone: 928-718-4852
  • Fax: 928-718-4856
Mailing address:
  • Phone: 928-718-4852
  • Fax: 928-718-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI 2635
License Number StateAZ

VIII. Authorized Official

Name: AMY ELSBURY
Title or Position: CEO
Credential: RN, BSN, MA
Phone: 928-718-4852